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Participant Acknowledgement of Risks

www.climb-outdoor.com

855-VA-CLIMB

In consideration of the services of Vertical Rock Outdoor School, LLC (VROS) located at 10225 Nokesville Rd., Manassas, Virginia 20110 their officers, agents, employees, directors, advisors, contractors and stockholders, and all other associated persons or entities (hereafter collectively referred to as “VROS”) I (Participant) agree as follows:

Although VROS has taken reasonable steps to ensure that I have appropriate equipment and a skilledguide(s) so I can enjoy an Activity for which I may not be skilled, VROS has informed me this Activity isnot without risk. Certain risks are inherent in the Activity and cannot be eliminated without destroying theunique character of the Activity. These inherent risks are some of the same elements that contribute to theunique character of this Activity and can be the cause of loss or damage to my equipment, serious injury,illness, or in extreme cases, permanent trauma or death. VROS Activity believes it is important for me to know in advance what to expect and to be informed of the inherent risks involved in the Activity. The following describes some, but not all, of those risks.

Activity Name: Backcountry Climbing Expedition (“Activity”)

Activity Description: Participants will learn the fundamentals of climbing, hiking and backcountry living in some of the most beautiful forests and parks of Maryland, Virginia and other areas that VROS or its affiliates CUA’s (commercial use authorization or “permit”) allow. Your instructor will emphasize development of the following skills: movement on rock, rope systems, anchors, protection placement, rappelling, belaying, lead climbing, hiking and back packing techniques and risk management. With a small student to instructor ratio; you will receive personal attention necessary to develop your climbing and backcountry skills.

Risk Summary: Participation in the Activity involves certain inherent risks, including, but not limited to the risk of death or serious personal injury resulting from falling, falling objects, equipment failures, and wild animals.

I am aware the Activity entails risks of injury or death to any participant. I understand the description of these inherent risks is not complete and that other unknown or unanticipated inherent risks may result in injury or death. I agree to assume and accept full responsibility for the inherent risks identified herein and those inherent risks not specifically identified. My participation in the Course is purely voluntary; no one is forcing me to participate, and I elect to participate in spite of and with full knowledge of the inherent
risks.

I acknowledge and understand that wearing a helmet is recommended by Vertical Rock Outdoor School LLC. If I choose not to wear a helmet, I do so against VROS’s advice.

I Agree

I agree that I will read and abide by all of VROS’s Rules posted on the VROS website at www.climb-va.com, and/or otherwise communicated to me. I understand that these rules of subject to update and modification and that I am responsible for monitoring this website for any updates and/or modifications.

I Agree

I grant VROS unrestricted permission to use my photographs, video recordings, and/or quotes in any VROS promotional material. 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.

I acknowledge that engaging in this Activity may require a degree of skill and knowledge different from other activities and that I have responsibilities as a participant. I acknowledge that the staff of VROS has been available to more fully explain to me the nature and physical demands of this Activity and the inherent risks, hazards and dangers associated with this Activity.

I Agree

I certify that I am fully capable of participating in this Activity. Therefore, I assume and accept full responsibility for myself, including all minor children in my care, custody, and control, for bodily injury, death, or loss of personal property and expenses as a result of those inherent risks and dangers identified herein and those inherent risks and dangers not specifically identified, and as a result of my negligence in participating in this Activity.

I have carefully read, clearly understood, and accepted the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon me, my heirs, assigns, personal representative, and estate and for all members of my family, including minor children.

First Participant's Name

First Name*

Middle Name

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

First Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

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Last Name*

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

First Name*

Middle Name

Last Name*

Phone*
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*
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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*
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.
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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