Loading...

Rock Climbing Release Form: Adult

In consideration of UNC Wellness Center (UNCWC) giving me the opportunity to participate in climbing activities, including, but not limited to, climbing, belaying, lowering on ropes, the right to engage in technical rock climbing, rock wall climbing, rock climbing classes, rappelling, and other activities related in any way to rock climbing activities provided to me by UNCWC (“Climbing Activities”), I, for myself, my personal representatives, assigns, heirs and next of kin, state and agree to the following:

ASSUMPTION AND ACKNOWLEDGEMENT OF RISK

I acknowledge, agree and represent that I understand the dangerous nature of Climbing Activities and that I am qualified, in good health, and in proper physical condition to participate in such activities. I acknowledge that Climbing Activities entail known, unknown and unanticipated risks, seen and unseen, which could result in physical or emotional injury, paralysis, death, and damage to property or third parties. I understand that such risks cannot be eliminated without jeopardizing the essential qualities of the activity. I have no physical or mental limitations which would preclude my safe use of the climbing walls, climbing equipment, or exercise equipment, or being in the landing zones (“Walls”) and/or I assume all risks that may be created by such limitations. I further certify that I am not currently mentally impaired or under the influence of drugs or alcohol, and am otherwise legally competent to understand and enter into this Agreement. I am assuming the hazard of this risk upon myself since I wish to climb at the UNCWC facility. The risks outlined in this Agreement are not exhaustive and I acknowledge that there may be other risks, hazards, and dangers that, based on the circumstances, are integral to Climbing Activities.

FACILITY RULES AND AGREEMENTS

I will comply with ALL UNCWC rules, both written and as stated to me by UNCWC during my participation in Climbing Activities. I will obey the UNCWC staff in regards to those rules as they affect my safety, other participants and observers, the property of UNCWC, and all resources used in conjunction with Climbing Activities. I agree and warrant that I will inspect each portion of the Climbing Activities in which I take part and that, if I find any condition which I consider to be unacceptable, hazardous, or dangerous, I will notify the UNCWC staff and refuse to take part in the Climbing Activities until the condition has been corrected. I understand that UNCWC reserves the right to refuse or terminate my participation in Climbing Activities for any non-discriminatory reason at any time.

I am aware of the recommended use of a protective helmet during Climbing Activities, which could prevent permanent brain damage or other injury in the event of an accident. I am also aware that I may provide and use my own protective helmet or that I may use a protective helmet provided by UNCWC.  I agree to use any such helmet according to the manufacturer’s specifications while participating in Climbing Activities and that, should I choose to participate in Climbing Activities without a helmet, I assume all risks associated with that decision.

I have read this agreement, understand its terms, and have signed it freely and without any inducement or assurance of any nature, and intend it to be a complete and unconditional assumption and acknowledgement of the risks of Climbing Activities. I also agree that if any portion of this Agreement is held to be invalid, illegal, or unenforceable, that portion of this Agreement shall be deemed separate, distinct and independent, and shall be ineffective to the extent it (i) invalidates the remaining provisions of this Agreement under applicable law or (ii) affects the legality, validity or enforceability of this Agreement.

I certify that I am at least 18 years of age and that no other representations have been made to me that change, alter, or modify anything within this Agreement. Additionally, I give UNCWC permission to use in its marketing materials any picture in which my likeness appears unless I notify UNCWC in writing otherwise.

Today's Date: April 18, 2024

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

First Name*

Last Name*

Emergency Contact's Phone Number*
How did you hear about us?

How did you hear about us? *
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 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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!