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Island Rock Climbing Gym - Participant Waiver

Island Rock Gym, Inc. Waiver:

Participant Agreement, Assumption of Risk, Unconditional Release and Waiver of Liability: Read this document carefully and in its entirety. This is a legally binding agreement that must be completed by all adult (ages 18 or older) participants, or by a parent or legal guardian for any participants under the age of 18. 

WARNING: CLIMBING IS DANGEROUS. THE POSSIBILITY OF GETTING INJURED CANNOT BE ELIMINATED FROM CLIMBING. YOU MUST BE WILLING TO ACCEPT AND MANAGE THIS RISK TO CLIMB.


Climbing is a dangerous sport! The individual named below (“I,” “me,” or “Participant”) desires to participate in rock climbing, including, but not limited to bouldering, tope rope belaying, and lead climbing (whether singular or plural, hereinafter referred to as the “Activity”) provided by Island Rock Gym, Inc. d/b/a Island Rock (hereinafter referred to as “IR”). For good and valuable consideration, including my ability to participate in the Activity, the receipt and sufficiency of which are hereby acknowledged, I agree to all the terms and conditions set forth in this agreement (this “Release” or “Agreement”). , 

1. I expressly assume all risk related to my participation in the Activity, whether by negligence or otherwise. I hereby agree on behalf of myself, and my heirs, representatives, successors and assigns (collectively, the “Releasing Parties”) to irrevocably release, waive and forever discharge IR, and its parents, subsidiaries, affiliates, divisions, agents, officers, owners, representatives, volunteers, employees, successors and assigns (collectively, the “Released Parties”) from any and all past, present and future claims, demands, causes of action, damages, losses, costs, expenses, judgments or liability of any kind in connection with the Activity and/or this Release, whether or not caused by any negligence or act or omission of the Released Parties (collectively “Claims”). I, on behalf of myself and the other Releasing Parties, acknowledge and understand that there may be facts discovered or claims incurred which were unknown at the time of execution of this Release which may have materially affected my decision to execute this Release if known at the time of execution, and I and the other Releasing Parties assume any such risk. I shall be liable for any attorneys’ fees incurred by IR and/or any of the Released Parties in connection with any claim brought in violation of this Release and I will defend, indemnify and hold harmless the Released Parties from any and all Claims of any kind related to or arising out of my participation in the Activity, or any breach or alleged breach by me hereof. 

2. I hereby understand and acknowledge that my participation in the Activity may require me to be exposed to and participate in certain rock climbing and climbing-like activities that may be considered dangerous such as climbing on or being near an artificial climbing wall, using fitness equipment, falling equipment or objects, using climbing training equipment, slacklining, rappelling, ascending ropes, incorrectly tied knots, harness malfunctions, improper loading belay devices, worn ropes, malfunctioning harnesses, improper clipping of systems, miscommunication between yourself and belayer, falling off the wall, slippery holds, mid-route course changes, letting go abruptly, loose, spinning and/or damaged artificial holds, holds broken off or falling from the wall, equipment failure, falling from a height, falling to the ground, on other users, or being fallen on by other users, abrasions from the walls, ropes, pads or the floor, belay and or belayer failure, climbing out of control or beyond one's personal limits, the negligence of other climbers, visitors, participants, or other persons who may be present, musculoskeletal injuries and/or over training, head injuries, cardio respiratory or other physical or mental stress, exposure to germs or viruses, physical presence at IR, using ninja fitness training equipment, using a locker room, and/or participating in yoga and/or fitness classes entail known and other climbing locker room, fitness and/or yoga related hazards (the “Dangerous Activities”). I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. 

Furthermore, IR employees have difficult jobs to perform, and they seek safety for all participants. They might be unaware of a participant’s fitness or abilities, so please let them know of any issues you may have with your fitness or ability so that they can assist you fully.

3. I acknowledge that I knowingly and voluntarily engage in such Dangerous Activities and I knowingly and freely accept and assume full responsibility for all risks, both known and unknown (even if arising from negligence of other persons released from liability hereunder), resulting from or relating to my decision to participate in the Activity, including, without limitation, the potential for harm, loss, physical and mental injury, emotional distress, paralysis, death, disability, bruising, chronic stress, breaking of bones, sprains, fractures, and dislocations in or around feet, ankles, knees, legs, hips, torso, shoulders, arms, elbows, wrists, hands, fingers, back, spine, neck, or head, finger tendon injuries, capsulitis, synovitis, impingements, elbow tendinitis, shoulder strains, disfigurement, physical and mental illness, and loss, damage, or injury to me or any other person or property resulting from or relating to me engaging in such Dangerous Activities. 

4. I further acknowledge that no representations or warranties of any kind whatsoever have been made to me regarding my own qualifications, fitness, or ability to participate in the Activity and/or in the Dangerous Activities, or regarding any of the equipment or services to be used in connection with the Activity and/or the Dangerous Activities, and that I participate and will use any and all equipment or services entirely at my own risk.

5. I further acknowledge and agree that all decisions regarding my participation in the Activities and any other activities in which I may participate in connection with the Activity shall be entirely my own and that the Released Parties neither influenced such decisions, nor made any representations to me concerning any such activities (including with limitation the physical, medical, and/or psychological consequences thereof). IN NO WAY HAVE I BEEN SUBJECTED TO ANY COCERCION, PRESSURE, OR UNDUE INFLUENCE BY THE RELEASED PARTIES TO ENGAGE IN THE DANGEROUS ACTIVIY(IES). 

6. I further acknowledge and agree that the Released Parties have no responsibility for my decisions and actions and have no obligations to me in connection with or as a result of my participation in the Activity or otherwise. I understand that IR, directly or through others, may provide various services, facilities, and/or equipment in connection with the Activity. I acknowledge that no one has made any warranties whatsoever with respect to any such facilities, equipment, and/or services, and that there are no warranties of any kind from anyone regarding fitness or suitability for use of any such facilities, equipment and/or services for any purpose in connection with the Activity. I waive any right I otherwise might have to warnings or instructions regarding any aspect of the Activity or any facilities, equipment and/or services utilized in connection with the Activity. I also understand that the use of any such facilities, equipment and/or services involves risk, I agree that I shall use any such facilities, equipment and/or services at my own risk, and I acknowledge that the waivers, releases, and indemnities contained in this Agreement and any other Agreement that I have executed or may execute in connection with the Activity expressly apply to my use of any such facilities, equipment and/or services. I accept and assume all risks, hazards, and dangers regardless of whether they are detailed in this Agreement. 

7. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.

8. I authorize IR to obtain emergency medical treatment for me if necessary and agree to be responsible for any and all associated costs thereof. 

9. I certify that I am physically fit to participate in the Activity and have disclosed any medical conditions that may affect my ability to climb safely. 

10. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.

11. This Agreement shall be governed by the laws of the State of New York without reference to its choice of law rules. I irrevocably consent to the exclusive jurisdiction and venue of the federal and state courts located in Nassau or Suffolk Counties with respect to any claim or suit arising out of or in connection with this Release and agree not to commence or prosecute any such claim or suit other than in the aforementioned courts. 

12. This Agreement constitutes the entire agreement between me and IR with respect to the matters described herein, and supersedes any and all other agreements and communications, oral or written, between myself and IR with respect to such matters. A signed copy of this Agreement delivered by facsimile, email, or other means of electronic transmission shall be deemed to have the same legal effect as delivery of an original signed copy of this Agreement. 

By signing this document, I acknowledge that I am of the age of 18 or older and have the right to contract in my own name with respect to this Agreement, or my Guardian has consented to my execution of same. This Agreement does not in any way conflict with any existing commitment on my part. I further acknowledge that if anyone is hurt or property is damaged during my participation in the Activity, I may be found by a court of law to have waived my right to maintain a lawsuit against IR on the basis of any claim from which I have released them herein.

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

I understand that climbing is dangerous. I understand that the possibility of getting injured cannot be eliminated from climbing. I am willing to accept and manage this risk to climb.

I Agree


General Facility Rules & Orientation:

All participants, and/or their parents or guardians, MUST have reviewed and fully executed the Participation Agreement, Assumption of Risk, Unconditional Release and Waiver Liability, watched the orientation video(s), and reviewed the full waiver and facility rules, posted throughout the facility and/or in the video attached to this document and/or posted within this document and/or any addendums to this document

I understand that climbing and/or bouldering is dangerous. The sport of climbing involves inherent, unavoidable risks and other risks, hazards, and dangers that can lead to serious injury and/or death and/or damage and destruction to equipment and property. By choosing to engage in the sport of climbing, Participants accept and assume responsibility for their own safety and actions and any losses or injuries they suffer resulting from the inherent and other risks of the sport.


The following activities and/or areas in the facility are age restricted:

  • Top Rope Climbing: Ages 4+ (min. age to climb at Island Rock)
  • Bouldering: Ages 14+
  • Ages 8-13 w/ mandatory parent and/or guardian supervision & spotting at all times;
  • Top Rope Belaying: Ages 15+
  • Lead Climbing: Ages 16+
  • Mezzanine Areas: Ages 15+

General Facility Requirements, Rules & Policies: 

  • All participants MUST check in at the front desk and have a valid waiver before participating in any activities.
  • All participants who are BOULDERING must also:
  • Meet the facility age requirements
  • Have a valid Bouldering Orientation Form on file.
  • All participants who are BELAYING on TOP ROPE must also:
  • Meet the facility age requirements
  • Have a valid Bouldering Orientation Form on file;
  • Have a valid Top-Rope Orientation on file;
  • MUST have a valid Island Rock Top-Rope Belaying Certification on file and pass the required Island Rock Top Rope Belay Certification Check/Test(s)
  • All participants who are LEAD CLIMBING or BELAYING ON LEAD must also:
  • Meet the facility age requirements
  • Have a valid Bouldering Orientation Form on file;
  • Have a valid Island Rock Top-Rope Belay Certification on file;
  • Have a valid Lead Orientation form on file;
  • MUST have a valid Island Rock Lead Belay and/or Lead Climb Certification on file and pass the required Island Rock Lead Belay and/or Lead Climbing Certification Check/Test(s).
  • No teaching of belaying, knot tying, and/or leading except by Island Rock staff.
  • All rappelling must be supervised by Island Rock.
  • All top-rope climbing must use ropes and belay devices provided by Island Rock.
  • Harnesses: must be commercial products designed for climbing with CE or UIAA certification (rescue, tree and fire equipment is not permitted).
  • Island Rock reserves the right to inspect and approve or refuse the use of any personal equipment. 
  • Helmets are available on request. Climbers may also use their own helmets.
  • All helmets must be CE or UIAA approved for climbing (non-Climbing helmets, such as bicycle or ski helmets, are not permitted).
  • All roped climbers must tie the rope directly into their harnesses with both a figure 8 follow-through and a fisherman’s knot.
  • No one under the age of 14 will be allowed to climb unless accompanied by an adult who shall be responsible at all times for their safety and conduct.
  • No one under the age of 15 may belay at Island Rock except in classes or lessons conducted by Island Rock.
  • All climbers must inform Island Rock of any accidents or equipment damage and of any situation seen as unsafe or not in accordance with Island Rock’s safety policies/rules.
  • Food is not allowed in the climbing area. 
  • No spectators in the climbing area. Climbers only.
  • No climbing barefoot or with open-toed shoes.
  • No pets allowed.
  • Objectionable language is not permitted. We are a PG-13 facility.  
  • Island Rock is not responsible for lost or stolen property.
  • Island Rock reserves the right to deny the use of its facility to anyone who fails to either comply with these safety policies or in any way compromises their own safety or the safety and enjoyment of others.

I Agree


My signature/initials indicate that I have reviewed and understand 100% of the information that I initialed above and in the video that I watched prior to filling out this document and that the climbing gym staff has presented this information to me. I understand that if I need additional assistance, orientation, instruction, training or assessment during my participation at the climbing facility at any future time that it is my responsibility to seek such assistance, orientation, instruction, training or assessment from the climbing gym staff prior to participating in any activity for which I am not trained or qualified or for which I doubt my abilities. I also agree that if any of my friends, family, or co-workers participate at Island Rock in the future, I will make sure they adhere to all of the rules & policies of Island Rock.

I Agree

August 11, 2026

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*

If participant is under 18 years of age: The undersigned (“Guardian”) represents and warrants that it is minor Participant’s parent or guardian. Guardian acknowledges that he/she/they understands the foregoing Release, that it is fair and equitable, and Guardian hereby gives his/her/their consent to its execution by Guardian’s child/ward and will not revoke Guardian’s consent at any time without notifying IR in writing in advance of such revocation. Guardian releases the Released Parties from any claims and causes of action Guardian may have against them of any nature whatsoever. Guardian hereby unconditionally guarantees the performance of Guardian’s child/ward’s obligation herein. 



By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.

Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Phone*
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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