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WAIVER AND RELEASE

In this agreement, any reference to “we”, “us”, “our” or “Joe Rockhead’s” shall be deemed to refer to 2616374 Ontario Limited operating as “Joe Rockhead’s Climbing Gym” AND  “Up The Bloc Climbing Inc.” and its directors, officers, employees, agents, affiliates, subsidiaries, successors and assigns.

RISK WARNING: There are significant elements of risk in any sport or activity associated with a “rock gym” climbing wall, bouldering area and incidental fitness training regimens and equipment (collectively referred to as the “Activity”). Although we have taken responsible steps to provide you with appropriate instructions and/or skilled instructors so you can enjoy the Activity, we remind you that the Activity is not without risk and that certain risks cannot be eliminated without destroying the unique character of the Activity. The same elements that contribute to the unique character of the Activity can cause loss or damage to your property or result in accidental injury, illness, or in extreme cases, permanent trauma or death.

ACKNOWLEDGMENT OF RISKS

I ACKNOWLEDGE THAT THE FOLLOWING DESCRIBES SOME, BUT NOT ALL THE RISKS INHERENT IN THE ACTIVITY:

  1. Injuries resulting from slips, trips, falls or painful crashes while using the facilities or equipment, climbing walls, bouldering areas, landing pits, floors below, climbing areas, work-out areas, bathroom facilities, or stairs;
     
  2. Injuries resulting from the fall of other persons who may come in contact with me or from any falls in which I come into contact with other persons;
     
  3. Injuries resulting from accidental or improper belaying;
     
  4. Injuries that occur from negligence or lack of training;
     
  5. The risk that my health and physical strength, coordination, sense of balance, and ability to follow or give directions while climbing, belaying, or working out may not be sufficient to practice safely the sport of indoor rock climbing;
     
  6. Fatigue, chill and/or dizziness, which may diminish my/our reaction time and increase the risk of accident;
     
  7. Abrasion from or entanglement with ropes and equipment or coming into contact with any walls or structures; or
     
  8. The presence, actions or falls of other participants be they accredited climbers or not.
     
  9. Improper landing on the bouldering mats resulting in severe injuries to the arms, legs, back and neck.

I understand the description of these risks is not exhaustive and that other unknown or unanticipated risks may result in injury, illness, or death.

HEALTH AND PHYSICAL CONDITION

I confirm that I am in proper physical condition and I suffer from no personal health issues that may prevent me from participating in the Activity.

ASSUMPTION OF RISKS

BY PARTICIPATING IN THE ACTIVITY, I VOLUNTARILY ASSUME ALL RISKS of personal injury, accidents and/or illness, including but not limited to: sprains, torn muscles and/or ligaments; fractured or broken bones; eye damage; cuts, wounds, scrapes, abrasions, and/or contusions; dehydration, oxygen shortage (anoxia), exposure and/or altitude sickness; head, neck, and/or spinal injuries; shock, paralysis, and/or death, even if injuries result in a manner that is not foreseeable at the time I sign this waiver and release.

I ASSUME FULL RESPONSIBILITY FOR CHOOSING A RESPONSIBLE PERSON TO BELAY ME.  I understand that through inattention, negligence or for other reasons, my belayer may drop the rope, fail to verify my harness and my knot, or take other actions that could result in my injury or death. I acknowledge the fact that an accreditation at Joe Rockhead's or by any other authority does not mean that the person holding the accreditation is an expert or that they are a responsible person.

I ASSUME FULL RESPONSIBILITY OF MY ACTS WHEN USING THE AUTO BELAY DEVICES. I understand that the auto belay devices are available when I have no one to belay me. I am solely responsible for following the instructions to make sure the device is working properly and that my harness is properly secured on the auto belay carabiner.

AGREEMENT TO ABIDE BY THE RULES AND REGULATIONS

I agree to abide by the rules and regulations of Joe Rockhead's and Up The Bloc, which are posted on the bulletin board on the floor of the gym. A written copy of the rules and regulations will be made available on request.  Joe Rockhead’s and Up The Bloc reserves the right to refuse to accredit any climber who does not pass our accreditation test.  Joe Rockhead’s and Up The Bloc further reserves the right to suspend or remove accreditation from any climber who demonstrates an unsafe attitude toward safety in indoor rock climbing while at Joe Rockhead's or Up The Bloc, or who does not obey the rules and regulations.

HELMET WAIVER

I understand that wearing a climbing helmet may reduce the risk of head injury and that it is my personal responsibility to decide whether I will use, or not use a helmet. If I choose to wear a helmet, it is my personal responsibility to provide my own helmet.

*I have read and understand the foregoing acknowledgment of risks and assumption of risks and responsibility and I will abide by the rules and regulations of Joe Rockhead's.

********** UNACCREDITED GUEST CLIMBERS **********

FOR ACCREDITED MEMBER AS HOST

As a host for a guest member, I acknowledge that I am responsible for putting on my guest(s)’s harness and for tying them in using a figure-eight knot. I am also responsible for my guest if he or she wants to use an auto belay device. I further understand that any breach of this rule may result in my guest(s) and I being asked to leave the premises, without refund. I understand that I must be 18 years of age or older in order to be responsible for a guest.

I also acknowledge that I am responsible for ensuring that my guest(s) read and understand the foregoing acknowledgment and assumption of risks and responsibility, and that each of them follow and comply with the rules and regulations of Joe Rockhead’s including any obligations of the guest(s) as may be set out in this acknowledgment.  Failure to do so may result in the suspension or termination of my membership.

I acknowledge that I have read and understood the rules concerning my being a host for guest members.

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FOR UNACCREDITED GUEST CLIMBER

If I am an unaccredited guest of an accredited climber at Joe Rockhead's, I acknowledge that I am not permitted to put on my own harness or tie my own figure-eight knot. I agree that I will not belay any climber while I am at Joe Rockhead's. Furthermore, I agree that I will not take instruction on any aspect of climbing safety while I am at the gym, except from a Joe Rockhead's instructor in the context of a Joe Rockhead's course. Climbing safety includes putting on my harness, tying the figure eight-knot or belaying. I further agree that any breach of this rule may result in my being asked to leave the premises, without refund.

I acknowledge that I have read and understood the rules concerning guest climbers.

*******************

WARNING: This agreement is legally binding. By signing, I give up the right to recover compensation from or against Joe Rockhead’s or Up The Bloc through the courts or otherwise, for any damage to property, personal injury or death, whether caused by negligence, accident, or otherwise.

RELEASE

BY SIGNING BELOW, I HEREBY ACKNOWLEDGE THE INHERENT RISK OF INJURY FROM THE ACTIVITY, THAT MY PARTICIPATION IS VOLUNTARY AND THAT 2616374 ONTARIO LIMITED AND UP THE BLOC CLIMBING INC AND ITS DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, AFFILIATES, SUBSIDIARIES, SUCCESSORS AND ASSIGNS (the “Releasees”) DO NOT ENDORSE OR MAKE ANY REPRESENTATIONS AND WARRANTIES REGARDING THE SAFETY OF THE ACTIVITY.

I HEREBY ACKNOWLEDGE AND ASSUME ALL RISKS ASSOCIATED WITH MY PARTICIPATION IN THE ACTIVITY.  I HEREBY WAIVE, RELEASE, AND FOREVER DISCHARGE THE RELEASEES FROM AND AGAINST ANY AND ALL CLAIMS, LIABILITIES, COMPLAINTS, DEMANDS, DAMAGES OR CAUSES OF ACTION, WHERE IN LAW, CONTRACT, TORT, STATUTE OR EQUITY, INCLUDING, WITHOUT LIMITATION, DEATH, BODILY INJURY, PROPERTY DAMAGE, OR ANY OTHER LOSS OR DAMAGE WHATSOEVER ARISING FROM MY PARTICIPATION IN THE ACTIVITY, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE (the “Claims”).

I AGREE TO INDEMNIFY AND HOLD HARMLESS, TO THE FULLEST EXTENT PERMITTED BY LAW, THE RELEASEES FROM AND AGAINST ANY AND ALL LIABILITY FOR ANY CLAIMS, INCLUDING ALL COSTS, EXPENSES AND LEGAL FEES EXPENDED BY THE RELEASEES.  I AGREE NOT TO MAKE ANY CLAIM, OR TAKE ANY PROCEEDINGS AGAINST ANY OTHER PERSON OR CORPORATION ENTITLED TO CLAIM CONTRIBUTION AND INDEMNITY UNDER THE PROVISIONS OF ANY STATUTE OR OTHERWISE, FROM THE RELEASEES IN RESPECT OF ANY CLAIM.

BY SIGNING BELOW, I HEREBY CONFIRM THAT I ACKNOWLEDGE AND CONSENT TO THE TRANSFER OF MY MEMBERSHIP FROM JOE ROCKHEAD’S CLIMBING GYM LTD. TO 2616374 ONTARIO LIMITED.

Dated: December 11, 2018 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Accredited Member Membership Number if Participant is a Guest
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Accredited Member Membership Number if Participant is a Guest
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Accredited Member Membership Number if Participant is a Guest
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Accredited Member Membership Number if Participant is a Guest
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Accredited Member Membership Number if Participant is a Guest
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Accredited Member Membership Number if Participant is a Guest
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Accredited Member Membership Number if Participant is a Guest
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Accredited Member Membership Number if Participant is a Guest
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Accredited Member Membership Number if Participant is a Guest
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Accredited Member Membership Number if Participant is a Guest
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*
I am the parent and/or legal guardian of the participant who is younger than 18 years of age (the “minor”). On behalf of the minor, I understand the nature and inherent risks of the Activity and believe the minor to be qualified to participate in the Activity. I hereby waive, release and forever discharge and agree to indemnify and hold harmless each of the Releasees from and against any and all claims, liabilities, complaints, demands, damages or causes of action, where in law, contract, tort, statute or equity, including, without limitation, death, bodily injury, property damage, or any other loss or damage whatsoever arising from the minor’s participation in the Activity, whether caused by the negligence of the Releasees or otherwise. On behalf of the minor, I further agree to be bound by all terms and conditions contained herein.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Accredited Member Membership Number if Participant is a Guest
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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