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6A Shenton Way #B1-03
OUE Downtown Gallery
Singapore 068815

Registration, Declaration and Indemnity Form – Boulder Movement®

Notice: THIS IS A LEGALLY BINDING CONTRACT. In consideration of my being permitted by Boulder Movement to use its Climbing Gym, and/or participate in any climbing program offered by the Boulder Movement, including, but not limited to, climbing lessons, training, birthday parties, rentals, special events, etc. I agree to the following waiver and release and I make these following representations: 

I HEREBY ACKNOWLEDGE THE INHERENT EXTREME RISKS IN BOULDERING/ROCK CLIMBING, including climbing on artificial surfaces. I realize that those risks include, but are not limited to: falls from or contact with walls or equipment, bad decision-making, inattention of other climbers, misuse or failure of equipment, holds which may have become loose or damaged, and accidents which cannot be foreseen. I acknowledge that the above list is not inclusive of all possible risks associated with the use of the facilities, and/or the sport of climbing and I agree that said list in no way limits the extent or reach of this release. I VOLUNTARILY ASSUME ALL RISKS WITH FULL KNOWLEDGE AND APPRECIATION OF THE DANGERS AND RISKS INVOLVED. 

I voluntarily agree to assume all risks of personal injury, including paralysis and death, which may occur while I am in the Climbing Gym, or participating in any event, program, birthday party or training at any time, whether or not under supervision of Boulder Movement personnel. I hereby knowingly and intentionally waive and release any and all claims or causes of action which might arise from use of the Climbing Gym or participation, and agree to indemnify, hold harmless and defend the Boulder Movement, its successors, assigns, officers, employees, volunteers, wall designers or builders, manufacturers, lessors and agents from all liability for any such damage, injury, paralysis or death which may result. This Waiver/Release shall be effective even though said loss, damage or injury results or has resulted from negligence, wrongful acts, omissions, breach of warranty or strict tort liability of the Boulder Movement or the other parties released. 

I am in good health and have not any known physical limitations, which affect my use of the Climbing Gym. I agree to pay attention to the state of the equipment I may use, and to advise staff members if I do any damage or notice damage or problems. I certify that I have read the posted rules, and accept responsibility for failure to abide by these rules. If the Boulder Movement personnel makes a specific request of or instruction to me, I agree to comply. I understand that indoor climbing is not the same as outdoor climbing, which requires additional skills, and I agree to seek qualified instruction before attempting to climb outdoors. 

I am at least 18 years of age and otherwise legally competent to sign this agreement. This waiver/release shall be effective and binding upon me and upon my assigns, 

heirs, representatives, guardians and administrators. If under the age of 18, this waiver/release is signed by a parent/guardian of the minor, and the undersigned waive any and all claims, and agree to indemnify and hold harmless Boulder Movement and its agents in the event of any injury to the undersigned or minor climber. 

I understand that this waiver/release is a contract. I expressly state that I have read, understand and am familiar with all its provisions and that I sign it of my own free will. I also agree to the follow the rules and etiquette listed on the second page of this document.

Boulder Movement Rules and Regulations

-All climbers and observers must check in at the reception counter before proceeding to the climbing areas.

-All climbers must read and complete the waiver/release form. Climbing is an inherently dangerous sport.

-Minors under the age of 18 must have the waiver completed and signed by their parent/guardian. 

-At NO time should anyone be climbing without climbing staff present. Parents must be present when children are 7 and under during open climbing. 

-NO open-toed shoes or bare feet climbing. 

-Shirts and climbing shoes are required at all times. 

-Staff reserves the right to inspect any personal equipment. 

-All incidents, accidents, wall damage and equipment damage MUST be reported to a Boulder Movement staff member immediately. 

-Tightening, loosening, or moving holds is not permitted without authorization from the climbing staff. 

-Please report any loose holds, and anything else you may believe is a safety hazard so we can correct it.

-All climbers MUST abide by the judgments of Boulder Movement. 

-Smoking is prohibited at all times.

-Do not stand underneath a climber.

-Courses or lessons have priority on routes. If an instructor requires the route you are on, you may be asked to move to another route.

-All persons using Boulder Movement’s facility are expected to be respectful to one another and conduct themselves in good order. Any person deemed by the Management to be behaving in an unsafe or disorderly fashion may be asked to leave the facility.

-Boulder Movement reserves the right to revoke facility privileges at any time.

-Bouldering/Climbing is only allowed over padded areas.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

I declare that I am:

  • Fit with no medical history and able to climb
  • I am able to make my own judgements regarding my equipment and climbing safety

First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

I declare that I am:

  • Fit with no medical history and able to climb
  • I am able to make my own judgements regarding my equipment and climbing safety

Third Participant's Name

First Name*

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

I declare that I am:

  • Fit with no medical history and able to climb
  • I am able to make my own judgements regarding my equipment and climbing safety

Fourth Participant's Name

First Name*

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

I declare that I am:

  • Fit with no medical history and able to climb
  • I am able to make my own judgements regarding my equipment and climbing safety

Fifth Participant's Name

First Name*

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

I declare that I am:

  • Fit with no medical history and able to climb
  • I am able to make my own judgements regarding my equipment and climbing safety

Sixth Participant's Name

First Name*

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

I declare that I am:

  • Fit with no medical history and able to climb
  • I am able to make my own judgements regarding my equipment and climbing safety

Seventh Participant's Name

First Name*

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

I declare that I am:

  • Fit with no medical history and able to climb
  • I am able to make my own judgements regarding my equipment and climbing safety

Eighth Participant's Name

First Name*

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

I declare that I am:

  • Fit with no medical history and able to climb
  • I am able to make my own judgements regarding my equipment and climbing safety

Ninth Participant's Name

First Name*

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

I declare that I am:

  • Fit with no medical history and able to climb
  • I am able to make my own judgements regarding my equipment and climbing safety

Tenth Participant's Name

First Name*

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

I declare that I am:

  • Fit with no medical history and able to climb
  • I am able to make my own judgements regarding my equipment and climbing safety

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*
How did you find out about us?
If it's "Others", let us know what it is in the field below

Others
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*

Last Name*

Relationship*

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

I declare that I am:

  • Fit with no medical history and able to climb
  • I am able to make my own judgements regarding my equipment and climbing safety

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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