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Assumption of Risk and Release of Liability: Elevation Bouldering Gym

Assumption of Risk and Release of Liability: Elevation Bouldering Gym

Everyone entering Elevation Bouldering Gym must complete this form.
All participants under the age of 18 must have this waiver completed by a parent or legal guardian.

Please read carefully.

In consideration of the services of Elevation Bouldering Gym and its activities including, but not limited to climbing, spotting, working out, fitness classes, yoga classes, weights, rings, adult/youth climbing classes, special events, competitions, camps, birthday parties, obstacle courses, and any other activity undertaken on the premises of Elevation Bouldering Gym (hereinafter collectively referred to as EBG Activities), I and/or my child and/or my dependent (collectively “I”, “me”, or “my”) hereby agree to release and discharge from all liability Elevation Bouldering Gym, its agents, owners, members, affiliates, investors, employees, instructors, contractors, volunteers, directors, and all persons or entities acting on their behalf, landlords, and property owners (hereinafter collectively referred to as EBG) on behalf of myself, children, parents, spouse or partner, heirs, assigns, personal representatives, guardians and estate as follows:

Acknowledgement of risk: I acknowledge, agree and represent that I understand the dangerous nature of EBG Activities. I acknowledge that EBG Activities entail both known, unknown and unanticipated risks, seen and unseen, including, but not limited to falling on padded and unpadded surfaces, falling and striking other people and/or objects, other people and/or objects falling on me, failure of any part of the climbing structure, flooring, building, training equipment, slide, failure or breakage of climbing holds, hold anchoring systems, climbing ropes, rings, obstacle course apparatuses, and slackline which could result in physical or emotional injury, paralysis, death, or damage to property or to third parties.

Assumption of risk: I voluntarily assume any and all risks known or unknown including, but not limited to property damage, emotional and physical injury, paralysis, illness or death associated with my participation in EBG Activities. I further certify that I am physically and mentally qualified to participate in EBG Activities. I agree to inform EBG if I am unsure in any way of my physical and/or mental ability to participate in EBG Activities. I further certify that I am willing to bear the costs of all consequences created, directly or indirectly, by having a mental or physical condition that compromises my ability to participate in EBG Activities.

Indemnification and agreement never to sue: I agree to indemnify, hold harmless, release from liability, and never to sue EBG for any physical or emotional damage or loss, liability and expense, including costs and attorney fees incurred by EBG to enforce this

Rules: I understand and agree to abide by EBG House Rules written and oral. I agree to never participate in EBG Activities while under the influence of drugs or alcohol.

Agreement to bear the cost of injury: I agree to bear the cost of any injury or damage I cause or suffer while participating in EBG Activities.

Medical Treatment: I release and forever discharge EBG from any claim whatsoever that may arise on account of any firstaid treatment or other medical services rendered in connection with an emergency during my participation in EBG activities.

Orientation: I have read and understand the orientation information provided directly above or beside this waiver station. I also understand that if I have any questions or am unsure of the contents of the orientation I can ask Elevation staff for answers and clarification.

Photo and video release: Photographs or video of EBG Activities may be taken and used by EBG at any time in any way that EBG sees fit including, but not limited to promotional or instructional use.

Governing law: EBG and I expressly agree that this Assumption of Risk and Release of Liability is intended to be as broad and inclusive as permitted by the laws of the State of Oregon, and that the laws of the state of Oregon shall govern this agreement.

Severability: If any provision of this agreement or its application to any person or circumstance is held invalid or void, the remainder of the agreement is not affected and remains in full force and effect. All other agreements verbal or in writing are void.

I have read this document in its entirety and I understand its content completely. By signing this waiver I agree to be bound by all of its terms. Furthermore, I certify that I am at least 18 years old on the date hereof, or that I am the parent or legal guardian of the participant.

Date: August 10, 2020

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*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's 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.
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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