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Fitness Suite & Training Release of Liability 
and Assumption of Risk

Boulder Shack – Fitness Suite Waiver

The participant (or supervising parent/ guardian) should read the following carefully and initial where indicated. The document should then be signed by the participant (or supervising parent/ guardian) in the signature box. 

Risks & Rules

  • By completing this waiver you must understand that you are not permitted to use any part of the bouldering wall, at any time, under any circumstance. 
  • Having completed this waiver, you may ONLY USE THE FITNESS SUITE without supervision. You may also use the scaffold bars in the training area if under the direct supervision of a professional climbing coach or fitness instructor. The scaffold bars must not be used without this professional and direct supervision.
  • I am aware of and accept any risks associated with the activities I am undertaking. 
  • I am responsible for my own actions, and those of anyone I am supervising.
  • Report to reception on each visit before you use the fitness suite & training area.
  • Keep bags and personal belongings clear of the area you are working in.
  • Report any safety concerns to a member of staff without delay.
  • I understand that my own music can be played through the sound system in the fitness suite; however, Boulder Shack requests this music to be clean of any swearing. 
  • If Boulder Shack is providing a session that includes the use of the fitness suite (e.g. induction plus, junior climbing clubs, junior climbing squads or a formal exercise class), these take priority with use of the space (unless this space is part of a paid booking). We will do everything we can to accommodate both groups where possible. 
  • Please put ALL equipment back in its designated place when you have finished using it.
  • I understand and acknowledge that the use of exercise equipment involves risk of serious injury, including permanent disability and death.
  • I understand and agree that Boulder Shack is not responsible for property that is lost, stolen, or damaged while in. on, or about the premises. 

Conditions of Use

Duty of Care – The rules of use (above) 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 must politely ask you to leave.  You also have a duty of care to act responsibility towards the other users of the centre.

Medical Conditions – If the participant has any sort of medical condition or pre-existing injury this may make it more likely that the participant is injured whilst using the fitness suite.  Please consult your doctor for advice about any extra risks involved.

Unsupervised Use of the Fitness Suite – Unless you are booked on to an instructed group your fitness suite session will not be supervised by Boulder Shack staff.  You should be familiar with the Risks & Rules of use; these are described above.  Staff will provide whatever help and advice they can, but instruction in the use of equipment will only be provided where it has been booked and paid for in advance.  If you are not confident in the use of any equipment or technique, then do not attempt to use it without the supervision of someone who is competent to do so. 

Ages – You must be 14 years or older to use the fitness suite without supervision. 14 to 17 year olds must have this waiver co-signed by a parent or legal guardian who give their consent. Under 14’s must be supervised by a responsible adult at all times.

By signing below, you are confirming that you have read, understood and agree to abide by the terms above.

Dated: February 18, 2019

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Signature*
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*
Parent(s) or 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*

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. You can withdraw your consent at any time. 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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