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Romper Room Climbing LTD. – Assumption of Risk by Parent or Legal Guardian for Youth (under 19)


ASSUMPTION AND ACKNOWLEDGEMENT OF RISK AND RESPONSIBILITY, AND INFORMED CONSENT BY PARENT OR LEGAL GUARDIAN FOR MINORS UNDER THE AGE OF 19

WARNING: READ CAREFULLY BEFORE SIGNING!

I am aware that the Minor Participant(s) named herein (the “Minor(s)”) will be participating in physical activities at my discretion and, where applicable, at the discretion of the Minor(s). These activities (collectively, “Climbing Activities”) could include all activities, events, services, use of the facility, or use of equipment provided, arranged, organized, conducted, sponsored, or authorized by Romper Room Climbing LTD. (the “Company”) including without limitation: climbing (lead, top-rope, auto-belayed, bouldering, and fitness training), rappelling, belaying, auto-belaying, stretching, competitions, demonstrations, orientations, training and instruction, seminars and courses, all school and instructional sessions, equipment rental, observing others engaged in Climbing Activities, and all other activities, events, and services in any way connected with or related to Climbing Activities either at the climbing gym or on its portable wall.


I UNDERSTAND THAT PARTICIPATION IN CLIMBING ACTIVITIES INVOLVES RISKS, DANGERS, AND HAZARDS INCLUDING THE RISK OF SERIOUS PHYSICAL AND/OR MENTAL INJURY, OR DEATH. I acknowledge that participation in Climbing Activities entails known and unanticipated risks that could result in physical or emotional injury, paralysis, or death to me, the Minor(s), or to third parties, or damage to my personal property, the property of the Minor(s), or to the property of third parties. I understand that these risks cannot be eliminated without jeopardizing the essential qualities of Climbing Activities. The risks include but are not limited to: slips, trips, and falls; scrapes, cuts, and bruises; muscle and joint sprains and strains; broken wrists, ankles, legs, and other bones; falling off of equipment; participants falling and falling on each other resulting in broken bones and other serious injuries including death; participants failing to wear their harness properly, participants failing to clip into the auto-belay device before climbing, or clipping the auto-belay device into the wrong part of the harness or into something other than an approved rock-climbing harness; in the context of roped climbing: swinging and penduluming; failing to climb or belay safely or within one’s own ability; failing to rappel safely or within one’s own ability; infectious disease such as viruses, bacteria, parasites, and fungi which may be transmitted through direct or indirect contact; failure to act safely on the part of instructors or supervisors or other climbers or belayers; failure of climbing equipment including ropes, auto-belay devices, harnesses, slings, anchor points, climbing holds, or any other equipment associated with or related to climbing or belaying; and misuse of any of the aforementioned equipment.

I am not aware of the Minor(s) having any existing health, mental, or physical conditions that may increase their risk in participating in Climbing Activities.

Each Minor has been informed that they must follow the rules and instructions communicated by the Company and its staff.

I understand that if the Company’s rules and staff instructions are not followed by the Minor(s), they may lose their privilege to participate in Climbing Activities.

I understand that putting on a harness, clipping into auto-belay devices, tying into ropes, and belaying are unsupervised tasks. I acknowledge that a Minor aged 12 or older must pass corresponding task-specific Company tests before performing these tasks, after which they are solely responsible for performing them properly, except when a Company instructor, camp leader, or supervisor has been specifically assigned to oversee their activities. For Minors under the age of 12, the Parent or Legal Guardian must pass corresponding task-specific Company tests before performing these tasks, after which they are solely responsible for performing them properly, except when a Company instructor, camp leader, or supervisor has been specifically assigned to oversee such activities.

I am not being persuaded or influenced in any way to permit the Minor(s) to participate in Climbing Activities or to sign this document by any oral, written, or visual representations or statements made by the Company or its directors, officers, employees, guides/instructors, agents, or representatives, or by anything else that might have been said or done.

HAVING THOROUGHLY CONSIDERED THE RISKS AND DANGERS OF CLIMBING ACTIVITIES, AND BASED UPON MY UNDERSTANDING AND ACKNOWLEDGEMENTS DESCRIBED HEREIN, I VOLUNTARILY CHOOSE TO PERMIT THE MINOR(S) TO PARTICIPATE IN CLIMBING ACTIVITIES.


August 19, 2025

First Parent or Legal Guardian's Name
First Name*
Middle Name
Last Name*
First Parent or Legal Guardian's Date of Birth*
Date of Birth
First Parent or Legal Guardian's Signature*
Second Parent or Legal Guardian's Name
First Name*
Middle Name
Last Name*
Parent or Legal Guardian's Date of Birth*
Date of Birth
Third Parent or Legal Guardian's Name
First Name*
Middle Name
Last Name*
Parent or Legal Guardian's Date of Birth*
Date of Birth
Fourth Parent or Legal Guardian's Name
First Name*
Middle Name
Last Name*
Parent or Legal Guardian's Date of Birth*
Date of Birth
Fifth Parent or Legal Guardian's Name
First Name*
Middle Name
Last Name*
Parent or Legal Guardian's Date of Birth*
Date of Birth
Sixth Parent or Legal Guardian's Name
First Name*
Middle Name
Last Name*
Parent or Legal Guardian's Date of Birth*
Date of Birth
Seventh Parent or Legal Guardian's Name
First Name*
Middle Name
Last Name*
Parent or Legal Guardian's Date of Birth*
Date of Birth
Eighth Parent or Legal Guardian's Name
First Name*
Middle Name
Last Name*
Parent or Legal Guardian's Date of Birth*
Date of Birth
Ninth Parent or Legal Guardian's Name
First Name*
Middle Name
Last Name*
Parent or Legal Guardian's Date of Birth*
Date of Birth
Tenth Parent or Legal Guardian's Name
First Name*
Middle Name
Last Name*
Parent or Legal Guardian's Date of Birth*
Date of Birth
Parent or Legal Guardian's Driver's License / ID Card
Driver's License / ID Card Number*
Issuing State*
Parent or Legal Guardian's Email Address
Email*
I agree to receive informational and promotional emails from Romper Room Climbing LTD
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Parent or Legal Guardian'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(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 19 years of age) and agree that they and the minor are subject to all the terms of this document.



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 Legal Guardian's Name
First Name*
Middle Name
Last Name*
Relationship*
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 Legal Guardian's Date of Birth*
Date of Birth
Parent or Legal Guardian's Signature*
Electronic Signature Consent*
 By checking this box, you are consenting to the use of your electronic signature in lieu of a physical signature on paper. You have the right to request to sign a paper copy instead, and by checking here, you are waiving that right. After providing consent, you may, upon written request to us, obtain a paper copy of your electronic records. No fee will be charged for such copies and no special hardware or software is required to view the records. 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, after which existing electronic signatures will remain valid, while new signatures will be completed physically. There is no penalty for withdrawing your consent. It is your responsibility to ensure that we have your current email address in order to contact you regarding any changes or concerns related to your electronic records.


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