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Vertical Rock, Inc.

1-855-VA-CLIMB

www.climb-va.com

 

"Building A Community Passionate For Climbing"

 

 

Acknowledgment and Assumption of

Risks, Release of Liabiltiy and Indemnification

Agreement

(Participant Agreement)

I ("Participant") agree that this Acknowledgement and Assumption of Risks, Release of Liability and Indemnification Agreement (Participant Agreement) is a binding legal agreement that I have carefully reviewed and agree to execute in consideration for Vertical Rock, Inc. ("Vertical Rock") permitting me to use its Indoor Climbing and Sports Center located at 10225 Nokesville Rd., Manassas, Virginia 20110 (Facility) and/or participate in Vertical Rock Indoor Climbing and Other Activities and/or Vertical Rock Outdoor Climbing and Other Activities and/or any other activity sponsored, promoted, or provided by or involving Vertical Rock (collectively, the Activities):

1. Acknowledgement, Understanding and Appreciation of Risks. I certify and represent to Vertical Rock that I personally know, understand, appreciate and acknowledge that using the Facility, and/or participating in the Activities involves certain inherent risks, including, but not limited to, the risk of death or serious personal injury. I have been given the opportunity to view the Activities in advance and ask questions and I have a full and complete understanding of the nature of each of the risks, including, but not limited to, the risk of falling, equipment failure or malfunction, and the possibility of injury from another participant. I understand that I may elect to climb without an instructor after receiving directions and specifically accept all risks of climbing without an instructor. I also understand that I may choose to climb in certain designated parts of the facility without a safety rope. I specifically accept the risks of climbing without a safety rope.

 

2. Assumption of the Risk. I agree to assume all such risks, as well as any other risks involved in using the Facility and/or participating in the Activities.

 

3. Release. In addition to expressly assuming the risks as set forth above, I agree to fully release and completely discharge Vertical Rock, Inc. and all of its employees, agents, partners, directors, shareholders, officers, independent contractors, subcontractors, sponsors, successors, representatives and assigns, as well as all other persons, or entities that may own, operate or manage the Facility and/or be involved in the Activities including, but not limited to: Nussbaumer Real Estate LLC, Edifice Building Group Inc, as well as Eldorado Wall Co Inc., and any and all other persons or entities that might have any liability whatsoever to me (collectively, the Released Parties), from and against any and all damages, actions, claims and/or liabilities, whether known or unknown, anticipated or unanticipated, suspected or unsuspected, relating to or arising from any activity, occurrence or event involving Vertical Rock, Inc, the Facility, or Activities to the maximum extent permitted by law.

 

4. Negligence. This Participant Agreement is intended to release and discharge the Released Parties from all damages, actions, claims and liabilities of any nature whatsoever, specifically including, but not limited to: damages, actions, claims, judgments and liabilities arising from, or related to, the negligence or gross negligence of the Released Parties to the maximum extent permitted by law. I further covenant not to sue or institute any claim against any Released Party for any claim released herein.

 

5. Indemnity. I agree to indemnify, hold harmless and defend Vertical Rock and each of the other Released Parties from and against any and all loss, damage, liability and/or expense, including costs and attorneys fees resulting from use of the Facility, or participating in the Activities.

 

6. Helmet. I understand that wearing a helmet is recommended by Vertical Rock. If I choose not to wear a helmet, I do so against Vertical Rocks advice. I agree to assume all risks of personal injury and/or death that may occur as a result of not wearing a helmet.

 

7. Governing Law. The laws of the Commonwealth of Virginia govern the rights and obligations of the parties to this Participant Agreement and the interpretation, construction and enforceability thereof. I agree that any lawsuit brought against any Released Party shall be brought solely in the courts of Virginia located in Fairfax or Prince William Counties.

 

8. Rules. I will read and abide by all of the Vertical Rock Participant and Observer Rules (Rules) posted at the Facility, on the Vertical Rock Website (www.climb-va.com), and/or otherwise communicated to me. I understand that the Rules are subject to update and modification. A copy of the current Rules is attached to this Participant Agreement. It is the responsibility of the Participant to monitor the Rules posted at the Facility and/or on the Vertical Rock website (www.climb-va.com) for any updates and/or modifications.

 

9. I grant Vertical Rock unrestricted permission to use my photographs, video recordings, and/or quotes in any Vertical Rock promotional materials. Promotional material includes, but is not limited to: news releases, videos, publications, interviews, displays, newsletters, advertisements, brochures and any website, or other type of electronic/digital use. All proprietary rights to the aforementioned media belong exclusively to Vertical Rock.

 

10. I HEREBY VOLUNTARILY WAIVE ANY RIGHT THAT I MAY HAVE TO A TRIAL BY JURY IN ANY ACTION, PROCEEDING OR LITIGATION INVOLVING ANY RELEASED PARTY.

 

11. THIS PARTICIPANT AGREEMENT IS A BINDING LEGAL AGREEMENT THAT I HAVE CAREFULLY READ BEFORE SIGNING.

 

 

 

Vertical Rock Participant and Observer Rules

 

General Rules

 

1. All participants and observers must check in at the front desk before proceeding to any climbing, or fitness areas.

 

2. All participants and observers must complete and turn in a Participant Agreement prior to climbing or participating in any fitness activity. All minors (18 years of age and under) must have a Participant Agreement signed by their parent or court appointed guardian. (Notes, phone calls, etc are not acceptable).

 

3. Youth under the age of 13 must be supervised by a responsible adult (18 years or older), or by a Vertical Rock staff member at all times.

 

4. All participants and observers must immediately report loose holds, worn ropes, and anything else they believe to be unsafe to a Vertical Rock Employee.

 

5. Vertical Rock is not responsible for lost or stolen items.

 

6. No one under 18 years of age is permitted on the upper level of the facility without a responsible adult.

 

7. No one under 13 years of age is permitted in the fitness areas without a responsible adult.

 

8. No one is permitted to climb, or belay until they pass the mandatory Vertical Rock Safety Test. (Minimum age for belaying is 13 years old).

 

9. No one is permitted to Lead Climb or Lead Belay until they pass the mandatory Vertical Rock Lead Climb and Lead Belay Test. (Minimum age to Lead Climb and Lead Belay is 13 without written management approval.)

 

10. All participants and observers must act reasonably and responsibly at all times, this includes, but is not limited to the following:

a. Observers and Participants not actively climbing/belaying must stay off padded floors.

 

b. Vertical Rock advises Participants and Observers to wear a helmet. Participants and Observers not wearing a helmet do so at their own risk.

 

c. Traversing must be kept under ten feet, or below the first lead draw clip.

 

d. Only Vertical Rock employees are permitted to teach safety skills/techniques, adjust ropes, anchors, hand/footholds, climbing routes and fitness machines.

 

e. No bouldering/climbing, or standing under another boulderer/climber (unless you are spotting).

 

f. Do not climb or boulder on a route that intersects another climber.

 

g. Only approved UIAA (International Mountaineering and Climbing Federation) climbing equipment in good condition is permitted.

 

h. Belayers must stand while belaying.

 

i. No swinging, or hanging on the climbing ropes or slack line.

 

j. Only one person is permitted on a slack line at a time.

 

k. Locking carabiners are required for all belay devices.

 

l. No food or liquids (except water) permitted on gray padded floors.

 

m. Remove all loose items before you climb.

 

I acknowledge that I have read Vertical Rock Participant and Observer Rules, that I fully understand them, and that they may be updated and modified from time to time. A current copy of the Rules will be posted at the Facility and on the Vertical Rock Website (www.climb-va.com).

 

First Climber's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Climber's Date of Birth*
Climber'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

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Questionnaire
How Did You Hear About Us?*

If You selected Other, Please Explain.
Have You Ever Climbed Before?*
No
Yes
TO BE SIGNED BY PARENT OR LEGAL GUARDIAN IF PARTICIPANT IS A MINOR I,represent that I am the parent or legal guardian of (Minor) and hereby consent to Minor using the Facility and/or participating in the Activities. In consideration for Vertical Rock, Inc allowing Minor to use the Facility, and/or participate in the Activities, I agree, personally, and on behalf of the minor individual, to be fully bound by the terms and conditions of this Participant Agreement. I further agree to indemnify, hold harmless and defend Vertical Rock, Inc. and all other Released Parties from and against any loss, damage, liability and expense, including costs and attorneys’ fees, incurred by Vertical Rock and/or the other Released Parties as a result of the above Minor using the Facility and/or participating in the Activities. __________THIS RELEASE IS A BINDING LEGAL AGREEMENT THAT I HAVE CAREFULLY READ BEFORE SIGNING IT.
Parent or Guardian's Name

First Name*

Middle 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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