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PARTICIPANT RISK ACKNOWLEDGEMENT, RELEASE, WAIVER OF CLAIM AND ASSUMPTION OF RISK FOR PROGRAMS WITH AN ELEMENT OF HIGH RISK. 

Read this document thoroughly before you sign.
Please bring this document to the first session and give it to the Program Instructor.
It must be signed and dated in order for you to participate. 


In consideration of participation in The Climbing Wall (The Program) offered at Vivo for Healthier Generations, I agree and acknowledge that: 

  1. I have (my child has) met all of the prerequisites required for participation in The Program.
  2. I (my child) will abide by the rules and regulations imposed on participants in The Program
  3. I freely and voluntarily acknowledge and assume any and all risks and hazards inherent in The Program (including personal injury or property loss), and accordingly, my participation in The Program is entirely at my own risk.
  4. I waive any claim I (my child) may have against Vivo arising from my (my child's) participation in The Program, and I will indemnify and save harmless Vivo, its employees and agents for any claim, including any claim for medical services arising from my (my child's) participation in The Program, except for the negligence on the part of Vivo, its employees and agents.
  5. I agree that by signing this Risk Acknowledgement, Release, Waiver of Claim and Assumption of Risk as a parent or guardian of a participant who is under the age of 18 years, I acknowledge that there are risks and hazards inherent in The Program to which I am willing to expose my child and I will pay for any costs incurred by Vivo, its employees or agents should a suit be launched on my child's behalf, except in the case of negligence on the part of Vivo, its employees or agents.
  6. Vivo may secure such medical advice and services as it, in its sole discretion, may deem necessary for my (my child's) health and safety and I shall be financially responsible for such advice and services. I understand that Vivo does not provide accidental death, disability, dismemberment or medical expense insurance on behalf of the participants in The Program and therefore agree to assume responsibility for such insurance coverage 
  7. I have CAREFULLY READ the Participant Risk Acknowledgement, Release, Waiver of Claim and Assumption of Risk and fully understand it and am freely signing it. 

Dated at Calgary, Alberta
Today's Date: January 15, 2019

This personal information is being collected under the authority of
The Freedom of Information and Protection Act, Section 33C
and is used solely for the purpose of
Vivo for Healthier Generations Safety Awareness. 

Bouldering & Climbing Wall Rules

  • All climbers please check-in with climbing wall staff before entering wall area at all times
  • Anyone not following safe and proper climbing behaviour will be asked to leave the climbing area
  • Children under 14 years must be supervised by a climber 14 years and older
  • Climbers 17 years and younger require parent/guardian authorization on the waiver
  • To respect other climbers, please keep voices at a reasonable volume
  • Do not walk underneath climbers or bump into users who are belaying
  • Climbing shoes or non-marking running shoes are mandatory
  • Bouldering on the main wall is only permitted to the height of boulder wall
  • Do not climb above or below any other climbers
  • Climb on designated rope route and do not climb sideways across the wall
  • Do not use bolts and bolt hangers as holds
  • First-time climbers must complete wall orientation, waiver, and belay test before being able to top rope
  • If a person does not complete the belay test, they will be asked to register in one  of our free drop-in classes or an introductory course
  • Children under 14 must be accompanied and spotted by a parent while bouldering (one to one ratio)
  • Please keep food and drink off mat area
  • Always safety check your partner before climbing
  • All climbers must complete an Auto Belay orientation before using it 

Today's Date: January 15, 2019

 

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Last Name*

Relationship*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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