Loading...

Please read the following document carefully, complete the information, then sign using a mouse or touch screen. Enjoy your visit!

CLIMBNASIUM, INC.

 

Indoor Rock Climbing Facility / Outdoor High Adventure Activity

ACKNOWLEDGMENT OF RISK, WAIVER AND RELEASE OF LIABILITY

 

WARNING: There are significant elements of risk in any adventure, sport, or activity associated with a “rock gym”, climbing wall, bouldering area, trips or climbing expeditions and equipment (referred to herein as “activity” or “activities”). The same elements that contribute to the unique character of the activity can be causes of loss or damage to your equipment or accidental injury, illness, or in extreme cases permanent trauma or death. By signing this Acknowledgment of Risk, Waiver and Release of Liability, you are agreeing to release the individuals and/or entities identified below from any and all liability from any such occurrence arising from the activity.

 

ACKNOWLEDGMENT AND ASSUMPTION OF RISKS: I certify that (a) I am at least eighteen (18) years of age, legally competent to sign this document, and physically and mentally capable of safely participating in the activities and (b) that any personal equipment and/or belayer I use as part of my participation in the activities is appropriate and properly qualified for such activity. I further acknowledge that if I misrepresent my age, capacity to sign this document, physical or mental capabilities, then I, or the minor on whose behalf I am signing, will be a trespasser upon the premises and, in the event of a loss of any type, will be entitled to no more rights than those of a trespasser. I recognize that there are inherent risks and dangers in using the facilities and equipment associated with the activities. These risks may result in serious injury or death. I understand that certain foreseeable and unforeseeable events can contribute to the unpredictability of the activity and that personal property may be lost or damaged. Should I use, or direct the use of, an auto-belay device during the activity, I acknowledge that I have been oriented to the proper usage of said device and that it is the climber’s responsibility to properly clip into the auto-belay device. I further acknowledge that any minors under the age of 13 must be supervised and connected to an auto-belay device by an adult. I also acknowledge that Climbnasium, Inc. may, in its sole discretion, prohibit the use of auto-belay devices during certain activities due to safety concerns. In recognition of the inherent risks of the activity which I, or the minor on whose behalf I am signing this document, will engage in, I assume full risk and responsibility for personal injury, accidents or illness (including death), and any related expenses, including attorneys’ fees and insurance deductibles. I also assume risk and responsibility for damage to or loss of my personal property. I also assume risk and responsibility for accidents or injuries that may be caused by the negligence of principals, officers, directors, shareholders, employees, agents and/or volunteers of Climbnasium, Inc., whether such negligence is comparable or contributory.

 

WAIVER AND RELEASE OF LIABILITY: In consideration of THE USE AND OPERATION OF THE ACTIVITIES PROVIDED BY CLIMBNASIUM, INC., and in recognition of the inherent risks of SAID activitIES, I agree, on behalf of myself, my heirs, representatives, successors, executors, administrators, and assigns, to hereby release, waive, discharge, and agree not to sue CLIMBNASIUM, INC., ITS PRINCIPALS, OFFICERS, DIRECTORS, SHAREHOLDERS, AGENTS, EMPLOYEES, AND/OR VOLUNTEERS, for any and all causes of action of any nature whatsoever which I may have, on account of any personal injury, property damage, death or accident of any kind, arising out of or in any way connected with the use of THE AFORESAID ACTIVITIES, AND/OR ANY OF THE FACILITIES AND/OR EQUIPMENT OF CLIMBNASIUM, INC., OR ANY CLIMBNASIUM TRIPS, WHETHER ORGANIZED, SPONSORED OR OTHERWISE, and I agree to indemnify and hold harmless the persons or entities mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of my actions.    I further AGREE TO WAIVE and RELEASE any claims against, AND NOT TO SUE, CLIMBNASIUM, INC., ITS PRINCIPALS, OFFICERS, DIRECTORS, SHAREHOLDERS, AGENTS, EMPLOYEES, AND/OR VOLUNTEERS, FOR ANY INJURY OR DAMAGE CAUSED BY ACTS OF its/THEIR OWN NEGLIGENCE WHICH MAY CAUSE PHYSICAL/MENTAL INJURY OR PHYSICAL DAMAGE TO MY PROPERTY.

 

WARNING, WAIVER, AND RELEASE OF LIABILITY RELATING TO CORONAVIRUS/COVID-19: The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is believed to be extremely contagious and the state of medical knowledge of its transmission, infection and treatment continues to evolve. The COVID-19 virus is believed to be spread from person-to-person contact and/or by contact with contaminated surfaces, objects, and even possibly through particles in the air. Infected individuals may be completely asymptomatic and still potentially spread the virus. Evidence has demonstrated that COVID-19 can cause serious and potentially life-threatening illnesses, including death. Climbnasium cannot prevent you, or any minors on whose behalf you may be signing this release, from being exposed to, contracting, or spreading COVID-19 while utilizing Climbnasium Inc.’s facilities, services, equipment, or premises. It is not possible to completely prevent the presence of the COVID-19 virus. THEREFORE, IF YOU CHOOSE TO USE CLIMBNASIUM INC.’S SERVICES AND/OR ENTER ONTO CLIMBNASIUM INC.’S PREMISES, YOU MAY BE EXPOSING YOURSELF TO AND/OR INCREASING YOUR RISK OF CONTRACTING OR SPREADING COVID-19. I HAVE READ AND UNDERSTOOD THE ABOVE WARNING REGARDING COVID-19. I HEREBY CHOOSE TO ASSUME THE FULL RISK AND RESPONSIBILITY OF CONTRACTING COVID-19 FOR MYSELF, AND/OR ANY MINORS ON WHOSE BEHALF I AM SIGNING THIS RELEASE, IN ORDER TO USE CLIMBNASIUM INC.’S SERVICES AND ENTER ITS PREMISES. I FURTHER AGREE TO WAIVE AND RELEASE ANY CLAIMS AGAINST, AND NOT TO SUE, CLIMBNASIUM, INC., ITS PRINCIPALS, OFFICERS, DIRECTORS, SHAREHOLDERS, AGENTS, EMPLOYEES, AND/OR VOLUNTEERS, IN CONNECTION WITH ANY EXPOSURE, INFECTION, CONTRACTION, AND/OR SPREAD OF COVID-19 RELATED TO CLIMBNASIUM INC.’S SERVICES AND PREMISES.

 

I accept that this agreement cannot be orally or otherwise modified.  I hereby agree and acknowledge that any claim or dispute arising from or related to the Acknowledgment of Risk, Waiver and Release of Liability granted herein or the relationship of the parties in any respect thereto shall be brought within twelve (12) months of any occurrence or discovery (or forever waived) and shall be settled only by mediation, or, if necessary to resolve the dispute, legally binding arbitration. Judgment upon mediation or arbitration award may be entered in any Court otherwise having jurisdiction and such mediation or arbitration is the sole remedy and is non-appealable.

 

THE UNDERSIGNED HAS READ THE ABOVE ACKNOWLEDGMENT OF RISK, WAIVER AND RELEASE OF LIABILITY, UNDERSTANDS THAT HE/SHE HAS GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND IS SIGNING IT VOLUNTARILY.

ADULT/PARENT SIGNATURE

August 2, 2021

 

 

SAFETY POLICIES AND PROCEDURES

The following are the Safety Policies and Procedures for Climbnasium, Inc. Responsibly following these policies and procedures reduces, but does not eliminate, the possibility of injury.

  • No climbing under the influence of alcohol and/or any controlled substances.
  • Each new belayer must be certified by a Climbnasium, Inc. facility staff member.
  • All climbing harnesses, knots and carabiners will be double checked by a Climbnasium certified belayer before top rope climbing will commence.
  • No unbelayed climbing over bouldering line (hand line). Failure to comply with this policy may result in the withdrawal of climbing privileges.
  • Spotters and a crash pad should be used when bouldering.
  • Helmets are recommended and are available upon request.
  • Do not walk/climb under or between a climber and his/her belayer.
  • No running or behavior not conducive to a safe environment.
  • All climbers must alert the Climbnasium, Inc. facility staff of any mental or physical limitations that would inhibit their participation in the climbing activity.
  • All accidents and injuries shall be reported to the Climbnasium, Inc. facility staff immediately.

Climbnasium, Inc. reserves the right to deny access to the Climbing facility to any person for any breach of this agreement or failure to strictly adhere to the Safety Policies and Procedures, or for any conduct that is viewed as unsafe, inappropriate or unhealthy.

 

Please select who will be participating... Parents that will be belaying need to click Adult and Minor
AdultMinor(s)Adult and Minor(s)
1 Minor2 Minors3 Minors4 Minors5 MinorsMore Minors6 Minors7 Minors8 Minors9 Minors10 Minors
Continue
First Participant's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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*

Phone*
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*

Middle Name

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

Emergency Contact's 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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!