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Minnewaska State Park Preserve - Peter's Kill Area

Acknowledgement of Risk Climbing Permit

*Valid for Present Climbing Season Only

The holder of this permit climbs with full knowledge of the dangers involved and assumes any risk of injury and death caused by the inherent dangers of the sport. It is understood that Minnewaska State Park Preserve does not maintain the rocks, cliffs, or other natural features of the terrain, does not provide supervision or instruction, does not approve qualifications or certify instructors in any manner, is not responsible for the condition of the terrain or acts of persons who may be on Minnewaska State Park Preserve property and is not responsible for climbing protection on the cliffs (as for example: bolts, pitons, rappel slings, rings, etc.).

• The holder of this permit recognizes natural hazards of forested, mountainous terrain and assumes all risk of personal injury caused by such hazards.

• The holder acknowledges that skill and training are essential in rock climbing.

• Be aware of the existence of other climbers and hikers and do not throw or kick any objects from cliff.

• Use service roads and marked access trails only, carry out all litter, do not disturb plants or wildlife.

• Dogs must be kept on leashes, six feet or less in length, at all times.

• Use clean climbing techniques only. The use of bolts and pitons are strictly prohibited.

• No fires, camping, motor vehicles, radios, glass containers, or alcohol.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Parent or Guardian must sign below if climber is under 18.



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*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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