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Release and Informed Consent Form for Climbing Related Activities

Release and Informed Consent Form

UNIVERSITY OF MARYLAND – University Recreation and Wellness ACTIVITIES INCLUDING ROCK CLIMBING WALL AND / OR CHALLENGE COURSE

In consideration of the University of Maryland permitting me to participate in rock climbing wall and/or Challenge Course, and related activities provided by University Recreation and Wellness (RecWell), I, on behalf of myself, my heirs, personal representative(s) and assigns hereby represent and agree as follows:

I understand that the RecWell Rock Climbing Wall and Challenge Course consist of a number of activity elements that range from two (2) feet to over fifty (50) feet off the ground, including a fifty (50) foot high ropes alpine tower, a fifty-five (55) foot climbing wall, a forty (40) foot traversing high course, slacklining, a giant swing, warm up games and group initiatives. I further understand that my participation in Rock Climbing Wall, Challenge Course and/or related activities is completely voluntary.

Upon signing this form, I acknowledge and agree that I must abide by all rules, regulations, expectations, and standards of conduct applicable to participation in Rock Climbing Wall, Challenge Course and related activities including.  I understand that the University reserves the right to limit or terminate my participation in any activity if, in the sole discretion RecWell Staff, my conduct or actions do not conform to said rules, regulations, expectations or standards of conduct or are otherwise dangerous, disruptive or destructive.

I fully recognize and understand that participation in Rock Climbing Wall, Challenge Course and related activities is physically demanding and involves substantial health, safety and other risks and hazards, both minor and serious, including but not limited to: cuts, scrapes, bruises, broken bones, muscle strains, pulls or tears, other bodily injuries, heat prostration, blindness, deafness, heart attacks, temporary or permanent disabilities, paralysis, brain damage, emotional stress, and even death.

I fully recognize and understand that Rock Climbing Wall and Challenge Course activities require a minimum level of fitness and experience for safe participation. I also understand that RecWell advises that Rock Climbing Wall and Challenge Course participants have a physical examination to determine their fitness for participation, and that climbing activities including, but not limited to, the Climbing Wall, Alpine Tower, Giant Swing, and High Ropes require participants to weigh less than 300lbs.  I further understand that the University of Maryland does not provide medical, health or other insurance for Rock Climbing Wall and/or Challenge Course participants.

I have had the opportunity to ask any questions that I may have about the Rock Climbing Wall, Challenge Course and/or related activities and the responsibilities and risks involved. All of my questions have been fully answered.

Knowing the dangers, hazards and risks associated with Rock Climbing Wall, Challenge Course and related activities, and with sufficient knowledge of my experience, physical condition and limitations, if any, I voluntarily assume all responsibility and risk of loss, damage, illness and/or injury to person or property that I may in any way sustain in connection with my participation in Rock Climbing Wall, Challenge Course and/or related activities. Participants may use their own personal equipment (i.e. harnesses, helmets, personal flotation device) provided this equipment meets industry standards and is in good working condition. Such equipment does not include carabiners or belay devices. RecWell reserves the right to deny use of personal equipment which fails to meet safety standards.  Participant is solely responsible for the maintenance of and damage related to their personally-owned equipment.

To the fullest extent permitted by law, I hereby release and forever discharge, and agree not to sue and to indemnify and hold harmless, the State of Maryland, the University of Maryland, University Recreation and Wellness, and their officers, agents, employees and volunteers from and against any and all liabilities, claims, demands, and causes of action of any kind on account of any loss, damage, illness or injury to person or property in any way arising out of or relating to my participation in Rock Climbing Wall, Challenge Course and/or related activities, and/or use of RecWell equipment or facilities, whether due to negligence, default or other action or inaction of any person or entity.

The University reserves the right to limit or terminate participation in any activity if, in the sole discretion RecWell Staff, a participant’s conduct or actions do not conform to RecWell rules, regulations, expectations or standards of conduct or are otherwise dangerous, disruptive or destructive.

I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THIS RELEASE AND INFORMED CONSENT FORM AND I SIGN IT VOLUNTARILY WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

 

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's UID #

UID # (If University of Maryland Student or Staff)
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's UID #

UID # (If University of Maryland Student or Staff)
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's UID #

UID # (If University of Maryland Student or Staff)
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's UID #

UID # (If University of Maryland Student or Staff)
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's UID #

UID # (If University of Maryland Student or Staff)
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's UID #

UID # (If University of Maryland Student or Staff)
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's UID #

UID # (If University of Maryland Student or Staff)
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's UID #

UID # (If University of Maryland Student or Staff)
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's UID #

UID # (If University of Maryland Student or Staff)
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's UID #

UID # (If University of Maryland Student or Staff)
Parent or Guardian's Email Address

Email*

Confirm Email*
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*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's UID #

UID # (If University of Maryland Student or Staff)
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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