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WARNING: THIS RELEASE IS LEGALLY BINDING. IF YOU ARE FILLING THIS OUT FOR A MINOR OR MINORS, YOU MUST BE THEIR PARENT OR LEGAL GUARDIAN. PLEASE READ CAREFULLY BEFORE SIGNING.

I desire to use the facilities, equipment, and/or programs of SALT PUMP CLIMBING CENTER LLC, d/b/a SALT PUMP CLIMBING CO., and GOOD REBEL HOLDINGS LLC (collectively, “Salt Pump”), located at 36 Haigis Parkway, Scarborough, ME, 04074 (the “Facility”). In consideration for Salt Pump permitting me to use the Facility, I have voluntarily agreed to execute this ASSUMPTION OF RISK, RELEASE OF LIABILITY, AND INDEMNIFICATION AGREEMENT (this “Release”) and hereby agree to the following:

A. Rules and Regulations of Salt Pump. I have read the rules and regulations of Salt Pump, posted throughout the Facility, and agree to abide by them. Failure to follow the rules and regulations of the Facility will result in expulsion from the Facility with no refund issued. A copy of these rules and regulations is also available upon request. Said rules and regulations may be amended at any time by Salt Pump.

B. Acknowledgment or Risk. I understand that there is a significant risk of serious physical injury, death and other damages inherent in indoor and outdoor climbing, bouldering and physical fitness training activities and in my use of the Facilities and instruction relating to these activities. These risks and hazards can include, but are not limited to, injuries arising from falling and striking objects or other people; being struck by falling objects or people; failure of or misuse of any part or all of the climbing structures, flooring systems, building, or slack line, rock rings, auto belays, and training and fitness apparatus; defective, worn, uneven, separated or additional flooring or pads; hazards created by additional pads; falling and failing to land on a pad; failure and/or breakage of climbing holds; failure of climbing hold anchoring systems and hardware; failure of anchoring systems, anchors and belay devices used to secure climbing anchors and ropes; falling because of improper use of ropes and safety equipment; strained or sprained muscles, joints and connective tissue; broken bones; personal injury including paralysis, death, illness, property damage, and other losses. Injury or death can arise from errors in judgment, from lack of training or information, from the negligence of me, employees or agents of Salt Pump or other parties, as well as the risks normally associated with athletic endeavors. There is no way to eliminate the risk of serious harm or death. I CERTIFY THAT I UNDERSTAND CLIMBING, BOULDERING, AND PHYSICAL ACTIVITIES, EXPOSE ME TO A HIGH RISK OF INJURY OR ACCIDENT.

C. Personal Condition. I certify that I have no emotional, psychological, medical, physical or other condition that could interfere with my use of the Facility, including, but not limited to, any interference with my ability to follow or give directions while climbing, belaying, participating in a class, using exercise equipment, participating in a camp or party, or any other activity within the Facility.

D. Helmets, Yoga, and Other Activities. If I choose not to wear a helmet, I agree to assume all risk of personal injury and death that may occur as a result of not wearing a helmet. If I see or hear anything that I feel is questionable or dangerous, it is my responsibility to ask or inform Salt Pump employees until corrected or satisfactorily answered. I realize that from time to time areas of the Facility may be darkened for events, yoga or any other reason Salt Pump sees fit. I understand and accept the risks of using the Facility under such circumstances. In addition, I agree to any physical adjustments made by yoga or other instructors during yoga or other classes unless I clearly state otherwise in writing. I accept any possibility of injury from the following: movements in class, the movements of others or adjustments made by the instructor.

E. Outdoor Climbing. I understand that indoor rock climbing is not the same as outdoor climbing and that additional skills and training are necessary for outdoor climbing that cannot be acquired indoors. I agree to seek qualified instruction before attempting to climb outdoors and hold harmless Salt Pump and all of its owners, members, affiliates, parents, subsidiaries, contractors, volunteers, insurers, managers, officers, employees, agents and representatives, as well as all other persons, corporations, or other entities that might have any liability to me (the “Released Parties”) for any outdoor or indoor climbing injuries I may incur.

F. Release. I also agree to release and discharge the Released Parties from and against any and all damages, actions, claims and liabilities, whether known or unknown, anticipated or unanticipated, suspected or unsuspected, relating to or arising from any activity, occurrence, or event involving the Facility or Salt Pump. This Release is intended to release and discharge the Released Parties from all damages, actions, claims and liabilities of any nature, specifically including, but not limited to, damages, actions, claims and liabilities arising from or related to the negligence of the Released Parties to the extent permitted by law.

G. Indemnification. I further agree to indemnify, hold harmless, and defend the Released Parties from and against any loss, damage, liability and expense, including any attorneys’ fees and costs, incurred by any of the Released Parties as a result of my using the Facility or participating in any activity sponsored by or involving Salt Pump.

H. Governing Law; Venue. The laws of the State of Maine shall govern the rights and obligations of the parties to this Release and the interpretation, construction, and enforceability thereof. I agree that any lawsuit brought against any of the Released Parties or otherwise in connection with my use of the Facility shall be brought solely in the federal or state courts of the State of Maine.

I. Promotional Materials. Salt Pump reserves the right to use any photograph, audio recording or video taken at the Facility, whether during the course of a party or private group, during a mountaineering expedition, during any class, during any climbing activity, or during any other activity at the Facility, involving Salt Pump or otherwise, in Salt Pump promotional materials, brochures, and website, and I grant Salt Pump the right to use my image and voice.

J. Other. This Release covers any and all activities undertaken by me in any part of the Facility or activity involving or sponsored by Salt Pump, including but not limited to the bathrooms, showers, observation areas, changing rooms, retail areas, climbing areas, classrooms, and offices. If any part of the Release is determined to be invalid, the remainder of the Release shall remain in full force and effect. This agreement constitutes the complete and sole agreement between Salt Pump and me. The section headings contained in this Release are for reference purposes only and shall not affect the meaning or interpretation of this Release. Individual Salt Pump officers, directors, Salt Pump members, employees, instructors, and agents have no authority or power to alter the terms of this Release, either orally or in writing.

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms as well as verbal direction that may be given by Salt Pump staff and employees.

I AM EIGHTEEN YEARS OF AGE OR OLDER.

I hereby execute this Release for myself and for my heirs, beneficiaries, personal representatives, executors, administrators, successors and assigns.

 

Date: September 20, 2019

First Participants Name

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Participants Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
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Parent or Guardian's Email Address

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Emergency Contact

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I represent that I am the parent or legal guardian of the above individual(s) and hereby consent to their use of the Salt Pump’s facility and/or participation in Salt Pump’s activities. In consideration of Salt Pump allowing the above-named participant(s) to participate and/or use the facility, I agree to be bound by the terms and conditions of this Release. On behalf of myself and my spouse or domestic partner, I hereby KNOWINGLY, INTENTIONALLY AND VOLUNTARILY WAIVE AND RELEASE, indemnify, hold harmless and forever discharge Salt Pump, its officers, directors, instructors, employees, agents, members and guests and all others associated with Salt Pump of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damage and liabilities, of every kind and nature, whether known or unknown, in law or equity, that said minor(s) ever had or may have, arising from or in any way related to such minor(s)’s participation in activities in connection with the Salt Pump. I further agree that I have full and sole responsibility for the safety and wellbeing of the above-named participant(s) while he or she is using Salt Pump facilities or participating in Salt Pump-related events. I further agree to indemnify, hold harmless and defend Salt Pump, its officers, directors, instructors, employees, agents, members and guests and all others associated with Salt Pump from and against any loss, damage, liability, expense, costs, and/or attorneys’ fees, including those brought by or on behalf of, or otherwise caused by the above-named participant(s).
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Gender*
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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