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Black Rock Bouldering Gym's

Activity Agreement and Waiver

Do not sign this form unless you have read it completely and understand and agree to its terms.

WARNING: There are significant elements of risk in any adventure, sport or activity associated with a “bouldering gym”, obstacle training area and incidental weight and fitness training regiments and equipment (referred to herein as “activity”). Although we have taken reasonable steps to provide you with appropriate equipment and or skilled instructors so you can enjoy an activity for which you may not be skilled, we wish to remind you this activity is not without risk at any competency level.

CLIMBING IS AN EXTREMELY HAZARDOUS AND DANGEROUS ACTIVITY AND INVOLVES BOTH INHERENT AND EXTRINSIC, AND BOTH NATURAL AND ARTIFICIAL RISKS.

Certain risks cannot be eliminated without destroying the unique character of the activity. 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.

In consideration of the services of Black Rock Bouldering Gym and its representatives, I, on behalf of myself and, jointly and severally, on behalf of my minor child(ren) listed as participants below, and on behalf of our respective heirs, personal representatives, spouse, next of kin, successors and assigns (hereinafter collectively “we”), hereby understand, acknowledge, and voluntarily agree with Black Rock Bouldering Gym, its shareholders, officers, directors, employees, agents, contractors, representatives, insurers and/or landlords, and each of their successors and assigns (hereinafter collectively the “GYM”) as follows:

We acknowledge that the following describes some, but not all of the risks one can face while participating in these activities.

  1. Slips, trips, falls or painful crashes while using the facilities or equipment, climbing walls, bouldering areas, landing mats, work out areas, lache bars, nets, ropes; physical demands involving crimping, dynoing, jumping or other movement of height, speed, jumps and vaults. Risks to walking on floors below or around the climbing/fitness areas, or bathroom facilities, mezzanine or stairs;
  2. Risks associated with traversing, climbing, or down climbing;
  3. Misuse of the equipment of facilities or failure of equipment;
  4. Users (our) physical strength, coordination, sense of balance, and ability to follow or give directions while climbing, belaying or working out;
  5. Fatigue, chill and/or dizziness, which may diminish the user’s (our) reaction time and increase the risk of accident;
  6. Abrasion from structures and/or equipment;
  7. The presence, actions or falls of other participants.

These are not all of the risks associated with our participation in the activities, and the above list in no way limits the scope of this Agreement. We also realize that climbing indoors is not the same as climbing outside, and that climbing outside requires additional training.

Our participation is entirely voluntary and with a full understanding that all such usage involves all manner of hazards and dangers. We choose to participate in spite of the risks. WE ACCEPT AND ASSUME ALL RISKS, BOTH KNOWN AND UNKNOWN, WHETHER CAUSED OR ALLEGED TO BE CAUSED BY THE NEGLIGENCE OR OMISSIONS OF THE GYM.

I Agree

We have a responsibility to ourselves and other users of the GYM, to conduct ourselves in a safe manner. If we are unsure about how to safely engage in any activities at any time, we will ask GYM staff for further instruction BEFORE participating. We are in good health and have no condition that will affect our safe participation in the activities. We hereby authorize any medical treatment deemed necessary in the event of any injury or illness while participating in the activities. We either have the appropriate insurance or, in its absence, agree to pay all costs of rescue and/or medical services as may be incurred on our behalf.

We will not use the GYM while under the influence of drugs or alcohol or while in any other condition that might impair us.

I Agree

We hereby voluntarily and knowingly forever WAIVE, RELEASE, AND DISCHARGE AND AGREE TO DEFEND, INDEMNIFY AND HOLD HARMLESS the GYM from ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, OR CAUSES OF ACTION WHATSOEVER for ANY harm, loss, damage, property damage, personal injuries or death alleged to be cause by the negligence (but not intentional conduct) in connection with our presence, participation in the activities and/or use of the GYM’s facilities or equipment.

I Agree

We understand that by signing this Agreement, if we or anyone else is hurt or property is damaged, among other things, we shall have (a) NO CLAIMS whatsoever against, (b) NO RIGHT TO SUE, and (c) NO RIGHT TO RECOVER ANY DAMAGES OR OTHER COMPENSATION from the GYM.

I Agree

We give the GYM permission to use our likenesses (photo or video) for promotional purposes, without compensation. If any term or provision hereof is invalid, illegal, or unenforceable, it shall be stricken only to the minimal extent necessary, and the remaining shall remain unimpaired. No provision can be waived or changed in any way (notwithstanding any purported oral statement or change on this Agreement) except expressly in writing personally signed by an owner of the GYM. All terms and paragraphs apply even if not initialed/checked. This Agreement is governed by the laws of the State of Arizona. This Agreement is irrevocable and has no expiration date.

I Agree

We agree to abide by ALL rules posted in the gym.

I Agree

I have had full opportunity to read and have read this entire agreement and rules, understand them and agree, jointly and severally, on behalf of myself and my minor child(ren), if any are listed as participants below, to be bound by their terms. I represent and agree that any minor children I list as participants below are, in fact, my own minor children or children over which I have been appointed as legal guardian by a court and, if not, I agree to defend, indemnify and hold harmless the Gym from any/all claims, loss, damabe, attorneys' fees and/or costs related to such minor child's participation.

I Agree

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle 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*
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*

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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