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Action Walls Registration Form for Supervised Adults. 

The following information will be used to complete a document that you will then read and sign. Please complete the following form to create this document. If the participant is under 18, you MUST complete the parental consent for climbing activities form, the parental consent for climbing activities form can only be completed and signed by a parent or legal guardian.

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*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

Phone*
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*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Medical Matters

Do you have any medical problems or taking any medication that you feel we should know about? (include all details about Asthma, Diabetes, Epilepsy if applicable)

Declaration of Fitness

I certify that to the best of my knowledge, I do not suffer from a medical condition which might have the effect of making it more likely that I be involved in an accident which could result in injury to myself or others

Declaration of Fact

I also confirm that the above information is correct and if any information changes I will notify the centre

The Auto Belay system has a maximum and minimum designed weight limit. Even if you are within the weight limit, your body shape may make participating more of a risk to you. In this case, the decision of participation will be at the instructors discretion.

ACTION WALLS WEIGHT LIMITS

MINIMUM Weight limit: 20kg

MAXIMUM Weight limit: 150kg

I confirm I've read and fully understood the above declarations and Action Walls weight limits? *
I Confirm
BMC Participation Statement

The British Mountaineering Council recognises that climbing and mountaineering are activities with a danger of personal injury or death. Participants in these activities should be aware of and accept these risks and be responsible for their own actions and involvement.

By signing this form I accept that I am only permitted to climb under the supervision of an allocated Climbing The Walls instructor in the Action walls area. 

Privacy and General Data Protection Regulations (GDPR) Policy

To comply with GDPR we are required to obtain your consent to collect and store your personal data. Climbing The Walls Ltd. is the Data Controller. We require your data to ensure that you comply with the conditions of use of the Centre. We will store your data securely and will not disclose it to any third party. At any time, you can request a copy of your data free of charge. GDPR makes provision for you to request to have your data removed and erased. This is known as the 'Right to erasure/ right to be forgotten'. When data is held for the establishment, exercise or defense of legal claims we have the right to refuse to erase the data. For this reason, our insurers insist that we continue to hold your data for 3 years from the date of your most recent visit.

In the case of Under 18 years olds, this is extended to 3 years beyond their 18th birthday. If you make a written request for erasure of your data, this request will be logged and the data will be erased after the period stated above.

In order to be allowed to use the facilities and services provided by Climbing The Walls you are required to consent to our Privacy and GDPR Policy. 

I consent to the Climbing the Walls Privacy and GDPR Policy.*
Yes
No
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*

Middle Name

Last Name*

Relationship*

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.


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