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VITAL Climbing Gym Youth Team Field Trip Permission Slip

LIABILITY RELEASE AND MEDICAL AUTHORIZATION

I consent for my child to participate in the activity named above. I understand that participation in the aforementioned activity, and in all climbing activities and its related and unrelated outdoor ancillary activities, involves a certain degree of risk and can be physically, mentally, and emotionally demanding and could result in severe injury or death. I have carefully considered the risk involved and have given consent for myself or my child to participate in this activity. I release the VITAL Climbing, LLC, the activity coordinators , all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation. 

If the Emergency Contact above cannot be contacted and an emergency exists, the undersigned parent or guardian authorizes arepresentative of VITAL Climbing, LLC to consent to X-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care deemed advisable and rendered by any licensed physician or surgeon, whether in the field, in the gym, or in licensed hospital. This authorization is given in advance of any required care and it is to empower a representative or official of VITAL Climbing, LLC to give consent for such treatment as a physician may deem advisable.

Parent/Guardian Signature:

Date: June 16, 2025

First Climber's Name
First Name*
Middle Name
Last Name*
Phone*
First Climber's Date of Birth*
Date of Birth
First Climber's Signature*
Second Climber's Name
First Name*
Middle Name
Last Name*
Climber's Date of Birth*
Date of Birth
Third Climber's Name
First Name*
Middle Name
Last Name*
Climber's Date of Birth*
Date of Birth
Fourth Climber's Name
First Name*
Middle Name
Last Name*
Climber's Date of Birth*
Date of Birth
Fifth Climber's Name
First Name*
Middle Name
Last Name*
Climber's Date of Birth*
Date of Birth
Sixth Climber's Name
First Name*
Middle Name
Last Name*
Climber's Date of Birth*
Date of Birth
Seventh Climber's Name
First Name*
Middle Name
Last Name*
Climber's Date of Birth*
Date of Birth
Eighth Climber's Name
First Name*
Middle Name
Last Name*
Climber's Date of Birth*
Date of Birth
Ninth Climber's Name
First Name*
Middle Name
Last Name*
Climber's Date of Birth*
Date of Birth
Tenth Climber's Name
First Name*
Middle Name
Last Name*
Climber's Date of Birth*
Date of Birth
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*
Field Trip Information
Destination and Purpose of Trip
Start Date of Trip
End Date of Trip
Approximate Departure and Return Times and Locations (if applicable)
Additional Chaperones, Volunteers, and Drivers (if applicable)
Climber Information
Climber's Name
Birth Date
Please explain any physical limitations, medical concerns, or allergies we should be aware of
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*
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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