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Action and Tall 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. 

ABC Participation Statement

"All climbing and bouldering activities have a risk of serious injury or death. Participants must be aware of and accept that even if they follow all good practice there may still be the risk of accident and injury. It is the responsibility of the participant to adhere to the conditions of use."

It is important that you understand this document. There is inherent risk involved with climbing centres and associated activities. By signing this form, you are stating you understand that these risks cannot be completely removed. If you do not understand any of the terminology or content, ask a member of staff to clarify.

By signing this form I accept that I am only permitted to climb under the supervision of an allocated Climbing Hut Shrewsbury instructor.

 

Conditions of Use of Centre

General Safety

  • Report to reception on each visit before you climb.
  • You must exercise care, common sense and self-preservation at all times.
  • Report any problems with the walls, equipment or other climbers' behaviour to a member of staff immediately. This is particularly important with broken or spinning holds. 
  • Be aware of the other climbers around you and how your actions will affect them.
  • Do not distract people while they are climbing or belaying. 
  • Never stand directly underneath someone who is climbing. 
  • If you have children, you must keep them under control and supervise them directly at all times. Be close enough to affect or control the child's behaviour at all times. 
  • Please make yourself aware of the location of the fire exits in the building and fire assembly points. 

As a user of this climbing wall, you must be aware of and accept the following: 

  • Volumes on the walls are designed to enhance the quality of climbing but you must be aware of and accept that when climbing above them there is an additional risk of falling onto them. 
  • Climbing beyond your capabilities on any wall is likely to result in a fall. Any fall may result in an injury despite the safety systems in place. You must make your own assessment of the risks whenever you climb. 
  • Participants must understand that climbing while pregnant can increase the risk posed to mother and unborn child. 
  • Participants must be aware and accept that climbing holds can spin or break 
  • You must do everything reasonable and practical to avoid endangering yourself or others. 
  • You have to be aware of and adhere to the safety rules of the centre at all times. 
  • Stand back from the climbing walls unless you are belaying or spotting a climber. 
  • You take responsibility for adequately maintaining your equipment. 
  • Please empty your pockets and remove all jewellery before climbing. 

 

Top Rope Climbing 

  • Always use a climbing harness to attach yourself to the rope tying the rope directly into the harness using a figure of 8 knot with a stopper, or a bowline knot with a stopper. 
  • Clipping in with a carabiner is not advised. 
  • Many of the climbs in the centre have top ropes already in place. Do not take them down or move them. 
  • It is your responsibility to vet your climbing partner's ability before they belay you. 

 

Lead Climbing 

  • Lead belaying requires a higher degree of skill and understanding from top rope belaying and should only be undertaken if you have received training or are competent to do so. If you are unsure do not climb and ask a staff member for available instruction at the centre. 
  • When using the lead walls, you must supply or rent (if available) your own appropriately rated dynamic rope. 
  • Quickdraws/runners/clips are provided on the lead wall. Please don't use your own. 
  • You must not skip clips and clips must be clipped in order. 

 

When Belaying 

  • Always abide by good practice when belaying. 
  • Always use a belay device attached to your climbing harness with a locking carabiner as per manufacturers' guidelines. 'Traditional', or 'body', belaying is not acceptable. 
  • To ensure your partner's safety, pay attention to what the climber is doing. 
  • Always stand as close to the climbing wall as is practical. Sitting or lying down is not acceptable. 


Auto Belays 

  • If you are unsure in any way on how to use an auto belay, or have never used one before, then ask a member of staff for assistance before using one. 
  • The coloured box (usually yellow or red) on the ground around the auto belays is a landing zone; be aware of descending climbers when standing within it. 
  • Good practice instructions are located next/near to the auto belay. To ensure your own safety, please follow these instructions. 

 

Our Duty of Care 

The conditions of use of the climbing centre are not intended to limit your enjoyment of the facilities; they are part of the duty of care that we, as operators, owe to you, the customer, by law. As such, they are not negotiable and if you are not prepared to abide by them then the staff may ask you to leave. 

 

Your Duty of Care 

You have a duty of care to act responsibly towards the other users of the centre, follow good practice and abide by the conditions of use of the centre. Statements of 'Good Practice' are posted around the centre adjacent to the relevant facilities. These describe the accepted methods of use of equipment and climbing areas. 

 


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
Conditions of Use

General Safety

  • Report to reception on each visit before you climb.
  • You must exercise care, common sense and self-preservation at all times.
  • Report any problems with the walls, equipment or other climbers' behaviour to a member of staff immediately. This is particularly important with broken or spinning holds. 
  • Be aware of the other climbers around you and how your actions will affect them.
  • Do not distract people while they are climbing or belaying. 
  • Never stand directly underneath someone who is climbing. 
  • If you have children, you must keep them under control and supervise them directly at all times. Be close enough to affect or control the child's behaviour at all times. 
  • Please make yourself aware of the location of the fire exits in the building and fire assembly points. 
As a user of this climbing wall, you must be aware of and accept the following: 

  • Volumes on the walls are designed to enhance the quality of climbing but you must be aware of and accept that when climbing above them there is an additional risk of falling onto them. 
  • Climbing beyond your capabilities on any wall is likely to result in a fall. Any fall may result in an injury despite the safety systems in place. You must make your own assessment of the risks whenever you climb. 
  • Participants must understand that climbing while pregnant can increase the risk posed to mother and unborn child. 
  • Participants must be aware and accept that climbing holds can spin or break 
  • You must do everything reasonable and practical to avoid endangering yourself or others. 
  • You have to be aware of and adhere to the safety rules of the centre at all times. 
  • Stand back from the climbing walls unless you are belaying or spotting a climber. 
  • You take responsibility for adequately maintaining your equipment. 
  • Please empty your pockets and remove all jewellery before climbing. 

Top Rope Climbing 

  • Always use a climbing harness to attach yourself to the rope tying the rope directly into the harness using a figure of 8 knot with a stopper, or a bowline knot with a stopper. 
  • Clipping in with a carabiner is not advised. 
  • Many of the climbs in the centre have top ropes already in place. Do not take them down or move them. 
  • It is your responsibility to vet your climbing partner's ability before they belay you. 
Lead Climbing 
  • Lead belaying requires a higher degree of skill and understanding from top rope belaying and should only be undertaken if you have received training or are competent to do so. If you are unsure do not climb and ask a staff member for available instruction at the centre. 
  • When using the lead walls, you must supply or rent (if available) your own appropriately rated dynamic rope. 
  • Quickdraws/runners/clips are provided on the lead wall. Please don't use your own. 
  • You must not skip clips and clips must be clipped in order. 
When Belaying 
  • Always abide by good practice when belaying. 
  • Always use a belay device attached to your climbing harness with a locking carabiner as per manufacturers' guidelines. 'Traditional', or 'body', belaying is not acceptable. 
  • To ensure your partner's safety, pay attention to what the climber is doing. 
  • Always stand as close to the climbing wall as is practical. Sitting or lying down is not acceptable. 

Auto Belays 
  • If you are unsure in any way on how to use an auto belay, or have never used one before, then ask a member of staff for assistance before using one. 
  • The coloured box (usually yellow or red) on the ground around the auto belays is a landing zone; be aware of descending climbers when standing within it. 
  • Good practice instructions are located next/near to the auto belay. To ensure your own safety, please follow these instructions. 

Our Duty of Care 

The conditions of use of the climbing centre are not intended to limit your enjoyment of the facilities; they are part of the duty of care that we, as operators, owe to you, the customer, by law. As such, they are not negotiable and if you are not prepared to abide by them then the staff may ask you to leave. 

Your Duty of Care 

You have a duty of care to act responsibly towards the other users of the centre, follow good practice and abide by the conditions of use of the centre. Statements of 'Good Practice' are posted around the centre adjacent to the relevant facilities. These describe the accepted methods of use of equipment and climbing areas. 



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 Hut Shrewsbury 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 Hut Shrewsbury you are required to consent to our Privacy and GDPR Policy. 


I consent to the Climbing Hut Shrewsbury Privacy and GDPR Policy.*
Declarations

PLEASE ANSWER 'YES' OR 'NO' TO THE FOLLOWING QUESTIONS. 

Are you over 18 years of age?*
Do you understand there is a risk of injury involved? **
Have you read and understood this Acknowledgment of Risk and Conditions of Use for climbing or bouldering? (If you have any questions inform a member of staff) **
Do you understand that failure to exercise due care could result in your injury or death?*
I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS*
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*

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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