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TayloredFit Solutions Assumption of Risk Liability Waiver and Media Consent Form 

360 Grand Av #318

Oakland, CA 94610

 

 

TAYLOREDFIT SOLUTIONS, LLC 

 

 

1.Assumption of Risk

The participation of you/child in this program is completely voluntary.  There are certain hazards and dangers inherent in the program, particularly, but not limited to the activities of indoor rock climbing, outdoor climbing, low and high impact team building activities, camping, and physical exercises.  TayloredFit Solutions, LLC [Emily Taylor and its associates] is committed to an extremely high standard of safety and excellence and has an accident-free safety record.  All of the equipment is inspected thoroughly and regularly.

TayloredFit Solutions, LLC [Emily Taylor and its associates] believes and practices emotional safety as well as physical safety in all programs. TayloredFit Solutions, LLC [Emily Taylor and its associates] does not permit drugs or alcohol use, verbal, physical sexual emotional and social harassment, or sexual activity during any TayloredFit Solutions, LLC [Emily Taylor and its associates] sponsored events or programs.  The participants are monitored by TayloredFit Solutions, LLC [Emily Taylor and its associates].

This program operates on a non-discriminating basis.

I Agree

I have read, understood, the risks involved in participation. I understand without signing this risk clause, (I)/participant cannot participate in activities hosted/sponsored by Taylored Fit Solutions, LLC  [Emily Taylor and its associates].

________

 

2. Liability Waiver

I understand that all programs and activities offered through TayloredFit Solutions, LLC [Emily Taylor and its associates] are inherently dangerous and sometimes conducted in an outdoor environment and involve a variety of activities which may be both physically and mentally demanding.  I understand that I/my child may be exposed to certain known and unknown risks such as physical strains, weather, insect bites, uneven terrain, and water hazards that could result in personal injury or loss of life. I understand that safety is ultimately personal responsibility, and therefore, I agree participate will always by own choice. I voluntarily release, forever discharge, and agree to hold harmless and indemnify TayloredFit Solutions, LLC [Emily Taylor and its associates], its agents and employees, and all other associates individuals and entities from any and all liability and claims that may arise from my participation in this program including legal fees associated with enforcement of this agreement.

I affirm that the medical information I have provided for the formentioned participant is both accurate and complete, and I am aware of no reason why I/my child should not participate. If I/participant requires medical attention and I am unable to authorize treatment, I agree to allow TayloredFit Solutions, LLC [Emily Taylor and its associates] to provide medical attention.

I Agree

I understand without signing this agreement, (I)/participant cannot participate in activities hosted/sponsored by TayloredFit Solutions, LLC  [Emily Taylor and its associates].

_____

 

First Participant Name

First Name*

Last Name*

Phone*
First Participant Date of Birth*
First Participant Information
Click to customize checkboxes *
Brown Girls Climbing Programs (Team, Summer Camp, Activities)
Consult/Leadership Learning (Teambuilding, Retreats, Panels)
Community Programs (Homsechool Rocks, On the Spectrum, Summer Camps, Health & Wellness Classes)
Training & Development (Coaching, Training)
Outdoor Guide (Rock Climbing: Bouldering, Top Rope, Sport), Hiking, Camping, Retreats)
Other

Today's date *
First Participant Signature*
Second Participant Name

First Name*

Last Name*

Phone*
Second Participant Date of Birth*
Second Participant Information
Click to customize checkboxes *
Brown Girls Climbing Programs (Team, Summer Camp, Activities)
Consult/Leadership Learning (Teambuilding, Retreats, Panels)
Community Programs (Homsechool Rocks, On the Spectrum, Summer Camps, Health & Wellness Classes)
Training & Development (Coaching, Training)
Outdoor Guide (Rock Climbing: Bouldering, Top Rope, Sport), Hiking, Camping, Retreats)
Other

Today's date *
Third Participant Name

First Name*

Last Name*

Phone*
Third Participant Date of Birth*
Third Participant Information
Click to customize checkboxes *
Brown Girls Climbing Programs (Team, Summer Camp, Activities)
Consult/Leadership Learning (Teambuilding, Retreats, Panels)
Community Programs (Homsechool Rocks, On the Spectrum, Summer Camps, Health & Wellness Classes)
Training & Development (Coaching, Training)
Outdoor Guide (Rock Climbing: Bouldering, Top Rope, Sport), Hiking, Camping, Retreats)
Other

Today's date *
Fourth Participant Name

First Name*

Last Name*

Phone*
Fourth Participant Date of Birth*
Fourth Participant Information
Click to customize checkboxes *
Brown Girls Climbing Programs (Team, Summer Camp, Activities)
Consult/Leadership Learning (Teambuilding, Retreats, Panels)
Community Programs (Homsechool Rocks, On the Spectrum, Summer Camps, Health & Wellness Classes)
Training & Development (Coaching, Training)
Outdoor Guide (Rock Climbing: Bouldering, Top Rope, Sport), Hiking, Camping, Retreats)
Other

Today's date *
Fifth Participant Name

First Name*

Last Name*

Phone*
Fifth Participant Date of Birth*
Fifth Participant Information
Click to customize checkboxes *
Brown Girls Climbing Programs (Team, Summer Camp, Activities)
Consult/Leadership Learning (Teambuilding, Retreats, Panels)
Community Programs (Homsechool Rocks, On the Spectrum, Summer Camps, Health & Wellness Classes)
Training & Development (Coaching, Training)
Outdoor Guide (Rock Climbing: Bouldering, Top Rope, Sport), Hiking, Camping, Retreats)
Other

Today's date *
Sixth Participant Name

First Name*

Last Name*

Phone*
Sixth Participant Date of Birth*
Sixth Participant Information
Click to customize checkboxes *
Brown Girls Climbing Programs (Team, Summer Camp, Activities)
Consult/Leadership Learning (Teambuilding, Retreats, Panels)
Community Programs (Homsechool Rocks, On the Spectrum, Summer Camps, Health & Wellness Classes)
Training & Development (Coaching, Training)
Outdoor Guide (Rock Climbing: Bouldering, Top Rope, Sport), Hiking, Camping, Retreats)
Other

Today's date *
Seventh Participant Name

First Name*

Last Name*

Phone*
Seventh Participant Date of Birth*
Seventh Participant Information
Click to customize checkboxes *
Brown Girls Climbing Programs (Team, Summer Camp, Activities)
Consult/Leadership Learning (Teambuilding, Retreats, Panels)
Community Programs (Homsechool Rocks, On the Spectrum, Summer Camps, Health & Wellness Classes)
Training & Development (Coaching, Training)
Outdoor Guide (Rock Climbing: Bouldering, Top Rope, Sport), Hiking, Camping, Retreats)
Other

Today's date *
Eighth Participant Name

First Name*

Last Name*

Phone*
Eighth Participant Date of Birth*
Eighth Participant Information
Click to customize checkboxes *
Brown Girls Climbing Programs (Team, Summer Camp, Activities)
Consult/Leadership Learning (Teambuilding, Retreats, Panels)
Community Programs (Homsechool Rocks, On the Spectrum, Summer Camps, Health & Wellness Classes)
Training & Development (Coaching, Training)
Outdoor Guide (Rock Climbing: Bouldering, Top Rope, Sport), Hiking, Camping, Retreats)
Other

Today's date *
Ninth Participant Name

First Name*

Last Name*

Phone*
Ninth Participant Date of Birth*
Ninth Participant Information
Click to customize checkboxes *
Brown Girls Climbing Programs (Team, Summer Camp, Activities)
Consult/Leadership Learning (Teambuilding, Retreats, Panels)
Community Programs (Homsechool Rocks, On the Spectrum, Summer Camps, Health & Wellness Classes)
Training & Development (Coaching, Training)
Outdoor Guide (Rock Climbing: Bouldering, Top Rope, Sport), Hiking, Camping, Retreats)
Other

Today's date *
Tenth Participant Name

First Name*

Last Name*

Phone*
Tenth Participant Date of Birth*
Tenth Participant Information
Click to customize checkboxes *
Brown Girls Climbing Programs (Team, Summer Camp, Activities)
Consult/Leadership Learning (Teambuilding, Retreats, Panels)
Community Programs (Homsechool Rocks, On the Spectrum, Summer Camps, Health & Wellness Classes)
Training & Development (Coaching, Training)
Outdoor Guide (Rock Climbing: Bouldering, Top Rope, Sport), Hiking, Camping, Retreats)
Other

Today's date *
Participant 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 Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Insurance

Insurance Carrier*

Insurance Policy Number*
Media Consent
3. Media Consent TayloredFit Solutions, LLC [Emily Taylor and its associates] incorporates technology and media into programs for the purpose of training, documentation, advertising and social media. Participants may consent to image and social media platform. I hereby consent and give permission to TayloredFit Solutions, LLC [Emily Taylor and its associates] to use my [adult] name/child [int], image, or video for training purposes, documentation, advertising and social media or other legal purposes without further approval or compensation.*
No
Yes
News Media/Press/Books [agree]*
No
Yes
TFS Brochures/Marketing [agree]*
No
Yes

Click to customize text

NewsLetter [agree]*
No
Yes
TayloredFit Solutions, LLC Webpage [agree]*
No
Yes
Sponsors*
No
Yes
Documentaries*
No
Yes
Facebook [agree]*
No
Yes
Contact Information

Primary Contact Name *

Primary Contact Phone *

Secondary Contact Name

Secondary Contact Email

Secondary Contact Phone

Emergency Contact *

Emergency Contact Phone *
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 Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian Date of Birth*
Parent or Guardian Information
Click to customize checkboxes *
Brown Girls Climbing Programs (Team, Summer Camp, Activities)
Consult/Leadership Learning (Teambuilding, Retreats, Panels)
Community Programs (Homsechool Rocks, On the Spectrum, Summer Camps, Health & Wellness Classes)
Training & Development (Coaching, Training)
Outdoor Guide (Rock Climbing: Bouldering, Top Rope, Sport), Hiking, Camping, Retreats)
Other

Today's date *
Parent or Guardian 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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