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SHAKTI Rock Gym
175 St-Viateur E  
Montréal, QC H2T 1B4

 

PARTICIPATION AGREEMENT and ASSUMPTION OF RISK

Warning: Bouldering is a high-risk activity. Even though standard indoor climbing industry security measures have been put in place, certain risks cannot be eliminated without compromising the particular characteristics of bouldering. These characteristics can result in accidental injury, illness, or in extreme cases, permanent injury or death.

 

I certify that:

  1. I am aware of and accept that bouldering, as well as those activities related to bouldering, as offered at Shakti Rock Gym inc. (hereafter referred to as ‘Shakti’) contain inherent risks of injury, accident, and/or illness including, but not limited to, sprains, fractures, torn muscles and/or ligaments, head, neck, and/or spinal injuries, paralysis, and/or death.
  2.  acknowledge the contagious nature of the Coronavirus/COVID-19 and that public health authorities recommend practicing social distancing. I further acknowledge that Shakti cannot guarantee that I will not become infected with the Coronavirus/Covid-19 while at Shakti. 
  3. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, gym staff, and other gym clients and their families.
  4. I voluntarily seek services provided by Shakti Rock Gym and acknowledge that I am increasing my risk of exposure to the Coronavirus/COVID-19.
  5. I agree to comply with all set procedures to reduce the spread while at Shakti.
  6. I agree not to go to Shakti, and accept that Shakti Rock Gym may refuse me access to the gym, if I have symptoms or a confirmed diagnosis of Coronavirus / COVID-19.
  7. I agree to notify Shakti Rock Gym as soon as possible if I have symptoms or a confirmed diagnosis of Coronavirus / COVID-19 after being at the gym.
  8. I understand and commit to following all Shakti rules. [1]
  9. If at any given time I feel my physical, mental, and/or emotional faculties deteriorating, I will immediately stop what I am doing and notify a Shakti employee.

By signing this agreement, I acknowledge having read and understood its contents, and I accept that bouldering, as well as those activities related to bouldering, as offered at/by Shakti, involve inherent risks. (If you are under 18 years of age, your parent or legal guardian must sign this agreement.)

 

SHAKTI RULES:

a. All participants must check-in at the front desk upon entering Shakti.

b. All participants must leave their shoes/boots on the shoe rack at the entrance.

c. Please keep your shirt on! Tank top minimum.

d. No climbing without climbing shoes. (Kids may climb in clean street shoes)

e. Never boulder above or underneath another climber.

f. Remove all watches and jewelry before climbing. These objects can cause injury. They’re also bad for the crash pads.

g. Don’t hang out on the landing pads when you’re not climbing. 

h. No climbing and/or hanging on ceiling pipes and wires.

i. Drugs, alcohol, or objectionable behaviour are not permitted.

j. Shakti is not responsible for damaged, stolen, or lost personal items. 

k. Climbers must keep a minimum of 3 meters distance between themselves and other climbers while on the wall. 

 

Today's Date: May 3, 2024

 

 


First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


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*

Last Name*

Phone*
Parent or Guardian's 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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