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Climbing Gym Risk Acknowledgment Form

GYM RULES

• Children under 16yrs of age must always be actively supervised by an adult.

• You must get a safety lesson from an Extreme Edge instructor if you have not received a safety lesson here before.

• You must be 14yrs or older to learn to belay (control the ropes) and must not climb or belay until you have had the required lesson(s) from an Extreme Edge instructor.

• If you do not fully understand the lesson(s) or any part of the lesson(s); it is your responsibility to make this known to an Extreme Edge instructor.

• You must get a lead assessment from an Extreme Edge instructor if you wish to lead and have not lead belayed or climbed here before.

• Your feet must be no higher than 1.5m off the ground if you are not attached to a rope.

• All climbers must be buddy checked by someone 14yrs or older and belayers must be buddy checked by the climber.

• No running, especially on red-carpeted areas. These are climber/belayer-only zones.

• Extreme Edge reserves the right to prohibit the use of any equipment we deem unsuitable or unsafe.

 

I acknowledge and accept that:

1. I am aware of, and understand that there is an inherent and unavoidable risk of injury associated with rock wall climbing, abseiling or belaying and that there is the possibility of bodily injury or death to myself or others and that there is also the possibility of loss or damage to property belonging to myself or others.

2. I agree to follow all rules listed above, as well as any and all instructions given to me by Extreme Edge staff and to use any equipment supplied by Extreme Edge in accordance with the instructions given. I accept that failure to do so increases the risk of injury or death.

3. I agree to comply with terms and conditions for participation, including the Gym Rules. If I observe any unusual significant hazard during my presence or participation, I will bring such to the attention of the nearest Extreme Edge staff member immediately.

4. I agree to always have a person properly belay me when attempting any climbing activity (other than bouldering). If I have any questions about the ability of a person to belay me properly, I will raise this with Extreme Edge staff before climbing.

5. I agree that I will not engage in any activity beyond my capabilities and will not cause any third party to be endangered by any of my actions while at Extreme Edge. I accept that Extreme Edge may withdraw me from any activity or take any other safety actions if Extreme Edge considers I may endanger myself or others.

6. To the extent permitted by law, I hereby release, waive, discharge and hold blameless Extreme Edge, Extreme Edge guides, and all persons, entities and contractors connected to Extreme Edge from any and all liability for death, disability, personal injury (including mental injury), property damage, property theft, loss of personal equipment and all other foreseeable risks, claims or actions of any kind (including negligence) whatever and however occurring which may arise, at any time, from or in connection with, directly or indirectly, as a consequence of me carrying out the activities of Extreme Edge. I note that this exclusion is subject to any rights or remedies I may have under the Consumer Guarantees Act 1993.

7. I certify that I am in good health, physically fit and have no physical or mental limitations or problems that would affect my safe participation or the safety of others in the Extreme Edge activities and have not been advised otherwise by a qualified medical person. I have disclosed to Extreme Edge of any medical condition, pregnancy, previous injury or medication that I am taking which may impact my ability to safely participate in Extreme Edge activities.

8. I understand that under New Zealand law the accident compensation scheme provides only limited assistance to visitors to New Zealand who suffer personal injury. I acknowledge that Extreme Edge strongly recommends that all visitors to New Zealand should have full insurance covering any personal injury they might suffer, including medical treatment cover.

9. I agree that this waiver is contractually binding on myself, my successors, my executors, administrators, heirs, next of kin and assigns and that should I or any of my successors, executors, administrators, heirs, next of kin or assigns assert a claim in contravention of this waiver, the asserting party shall be liable for all the expenses (including legal fees on a solicitor-client basis) incurred by the other party or parties in defending the claim.

10. I agree that Extreme Edge can use the information I provide for use in its internal operations and to contact individuals if needed. If at any point I require this information it will be provided by Extreme Edge. 

11. When hiring specialized equipment or booking with us, we ask that you leave a Card, Key, or ID (or similar) until the Booking is paid or the equipment is returned. Feel free to discuss this with the manager of the day if you have any questions. The property is kept in a staff-monitored location behind the counter, away from the public.

12. I have and read and understood the conditions of this waiver and acknowledge that by signing below I am accepting these conditions.

Date: April 25, 2025


First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
I agree to complete safety checks. This includes but is not limited to; Self-checks, Buddy checks, and if accompanying a Minor (under 16) checking their carabiners and actively monitoring them while they are at the Extrem Edge.*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
I agree to complete safety checks. This includes but is not limited to; Self-checks, Buddy checks, and if accompanying a Minor (under 16) checking their carabiners and actively monitoring them while they are at the Extrem Edge.*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
I agree to complete safety checks. This includes but is not limited to; Self-checks, Buddy checks, and if accompanying a Minor (under 16) checking their carabiners and actively monitoring them while they are at the Extrem Edge.*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
I agree to complete safety checks. This includes but is not limited to; Self-checks, Buddy checks, and if accompanying a Minor (under 16) checking their carabiners and actively monitoring them while they are at the Extrem Edge.*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
I agree to complete safety checks. This includes but is not limited to; Self-checks, Buddy checks, and if accompanying a Minor (under 16) checking their carabiners and actively monitoring them while they are at the Extrem Edge.*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
I agree to complete safety checks. This includes but is not limited to; Self-checks, Buddy checks, and if accompanying a Minor (under 16) checking their carabiners and actively monitoring them while they are at the Extrem Edge.*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
I agree to complete safety checks. This includes but is not limited to; Self-checks, Buddy checks, and if accompanying a Minor (under 16) checking their carabiners and actively monitoring them while they are at the Extrem Edge.*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
I agree to complete safety checks. This includes but is not limited to; Self-checks, Buddy checks, and if accompanying a Minor (under 16) checking their carabiners and actively monitoring them while they are at the Extrem Edge.*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
I agree to complete safety checks. This includes but is not limited to; Self-checks, Buddy checks, and if accompanying a Minor (under 16) checking their carabiners and actively monitoring them while they are at the Extrem Edge.*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
I agree to complete safety checks. This includes but is not limited to; Self-checks, Buddy checks, and if accompanying a Minor (under 16) checking their carabiners and actively monitoring them while they are at the Extrem Edge.*
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*
Can we 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 Information
I agree to complete safety checks. This includes but is not limited to; Self-checks, Buddy checks, and if accompanying a Minor (under 16) checking their carabiners and actively monitoring them while they are at the Extrem Edge.*
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. 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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