Loading...

WAIVER OF LIABILITY AGREEMENT

PLEASE READ CAREFULLY, THIS IS A LEGAL DOCUMENT

WARNING: BY SIGNING THIS AGREEMENT, YOU WILL GIVE UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE TO RECOVER COMPENSATION FOR ANY ACCIDENT, INJURY, LOSS OR DEATH TO YOURSELF/ OR THE MINOR, OR ANY DAMAGE/LOSS TO YOUR/ OR THE MINOR’S PROPERTY ARISING OUT OF YOUR/ OR THE MINOR’S PRESENCE AT AND USE OF BLOCS CLIMBING WALLS, EQUIPMENT, OR ANY OF THE FACILITIES AT BLOCS (“BLOCS”).

Participants under 18 years of age (“The Minor”) require the witnessing and signature of a parent or legal guardian to this document before being allowed to use BLOCS facilities.

I understand that it is my personal responsibility to consult with my physician prior to my participation in any programs or physical activities at BLOCS.

I also understand that if at any time during any programs or physical activities, if I feel discomfort or strain it is my responsibility to cease the activity and consult with my physician. I understand that BLOCS reserves the right to refuse admission to anyone that BLOCS think may pose a health risk to themselves or to others. I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activities at BLOCS.

Initials of Participant (if 18 years or older) or Parent/Legal Guardian (if Participant is a Minor.)

ACKNOWLEDGMENT OF RISKS:  I ACKNOWLEDGE AND AM AWARE THAT THE FOLLOWING DESCRIBES SOME, BUT NOT ALL THE RISKS AND DANGERS OF USING BLOCS’ FACILITIES AND ACCEPT SAME ENTIRELY AT MY/OR THE MINOR’S OWN RISK:

  1. Slips, trips, falls or painful crashes while using the facilities or equipment, bouldering areas, landing pads, floors below, or adjacent to bouldering areas, work-out areas, bathroom facilities, or steps;
  2. Risk associated with traversing, climbing, down-climbing or dismounting from the climbing wall;
  3. The presence, actions or falls of other participants be they accredited climbers or not;
  4. Failure or misuse of holds, anchor points, other climbing equipment, or any part of the climbing walls;
  5. The risk that my health and physical strength, coordination, sense of balance, and ability to follow or give directions while climbing, spotting, or working out may not be sufficient to practice safely the sport of indoor rock climbing/bouldering;
  6. Fatigue, chill and/or dizziness, which may diminish my/our reaction time and increase the risk of accident;
  7. Cuts and abrasions resulting from skin contact with climbing panels and various holds, ledges, edges and any fixture, including injuries to the joints and knuckles of the hands;
  8. All manner of injury, including but not limited to bruises, scrapes, cuts, sprains, strains, dislocations, broken bones, and head, facial, or dental injuries, resulting from falling while using the climbing walls and impacting against climbing wall faces, protruding ledges, wall supports, any floor or padded flooring, or any other permanent or temporary fixture, or other persons;
  9. Injuries or death resulting from the actions or omissions of others, including but not limited to falling climbers or dropped items such as (but not limited to), climbing hardware, wall parts, holds, or personal effects;
  10. Injury or death due to improper use of equipment or spotter error;
  11. Failure to follow the instructions of the staff of BLOCS, or failure to ask for information or assistance.  

I acknowledge and understand that the above list is not inclusive of all possible risks associated with the facilities of BLOCS and climbing and that other unknown or unanticipated risks may result in injury, illness, or death. The above list in no way limits the extent or reach of this assumption of risk, release of liability, and indemnification. I understand that no amount of care, caution, instruction or expertise can eliminate the inherent dangers associated with these activities.

If executing this Agreement on behalf of the Minor, I acknowledge and agree that the Minor’s presence at and use of BLOCS has inherent dangers, including but not limited to the risks listed above, and that I have read to the Minor the above risks and initialed this section on behalf of the Minor.  

Initials of Participant (if 18 years or older) or Parent/Legal Guardian (if Participant is a Minor.)

I hereby acknowledge and agree to the following:

In consideration of the use of the climbing walls, equipment, and any of the facilities of BLOCS, I hereby release, waive, and discharge BLOCS, their affiliates, members, officers, directors, shareholders, employees, coaches, instructors, volunteers, agents, independent contractors, the landlord/owner of the buildings, the designers and engineers, manufacturers, installers and distributors of BLOCS’S artificial climbing walls and other equipment, and any of their respective members, officers, directors, employees, agents, or representatives, or any one or more of them (collectively, the “Released Parties”) from any and all liability, actions, causes of action, suits, debts, statutory obligations, sums of money, claims and demands of every nature and kind whatsoever, at law or in equity, which I/ or the Minor ever had, now have, or which I/ or the Minor may at any future time have against the Released Parties, or any one or some of them, arising out of or in any way connected with my/ or the Minor’s participation in any activity at BLOCS, including claims that allege negligent acts or omissions of the Released Parties, or claims arising from any statute, including, without limitation, the Occupiers’ Liability Act, R.S.A. 2000, c. O-4 (collectively, the “Claims”).

I agree to indemnify and/or totally compensate the Released Parties from and against all Claims arising as a result of my or the Minor’s participating in any activity at or on the premises of BLOCS, including, without limitation, use of the climbing walls, equipment, and facilities. I agree to pay for all legal fees that are incurred as a result of any Claims made by me or on my behalf, or on the Minor’s behalf, or that are otherwise related to or caused by my or the Minor’s actions or inactions.

I understand that by signing this Agreement, I am giving up the right to sue or make any Claim against the Released Parties on my behalf or on behalf of the Minor, and that this Agreement shall be binding on the heirs, executors, administrators, assigns, and personal representatives of myself or the Minor.

If any portion of this Agreement is held invalid, I agree that the remainder of the Agreement shall remain in full legal force and effect.

I appreciate that this Agreement applies whether the Released Parties are at fault or not and it limits the liability of all of the Released Parties, notwithstanding that not all of the Released Parties are formal parties to this Agreement. I understand that in securing execution of this Agreement by myself or by myself on behalf of the Minor, is acting as agent or trustee on behalf of or for the benefit of the Released Parties, who shall to this extent be or be deemed to be parties to this Agreement.

Initials of Participant (if 18 years or older) or Parent/Legal Guardian (if Participant is a Minor.)

I agree that the Released Parties are not responsible in the event of loss, damage, unauthorized use, theft, or injury resulting from and to any personal property that I or the Minor bring onto the premises of BLOCS.

I understand that BLOCS has general rules and equipment-specific rules. I understand that general and equipment-specific rules are posted in the facility of BLOCS.

I agree that I will read and ensure that I understand the rules of BLOCS, or that I will read to the Minor and ensure that the Minor understands the rules of BLOCS, and that I or the Minor will abide by those rules, as well as others verbally stated by BLOCS staff, or employees and those posted throughout BLOCS.

I understand that BLOCS shall not be responsible for the safekeeping, loss, theft or damage of my property or the property of any person that is brought into the Facility.

I understand that should I or the Minor damage or break any of BLOC ’s equipment or property, I shall be liable for the reasonable cost of necessary repairs or replacements to such equipment or property.

I authorize BLOCS to use, store or transfer, as BLOCS may consider necessary, my, or the Minor’s, personal information, for any and all purposes in connection with the Facility and services provided by BLOCS and/or for the purpose of promoting, improving and furthering the interests of BLOCS. I acknowledge this may include posting my, or the Minor’s photos and/or names online, and/or in publications.

Initials of Participant (if 18 years or older) or Parent/Legal Guardian (if Participant is a Minor.)

 I have read and understood this Agreement and am executing this Agreement freely and voluntarily without any compulsion on the part of the Released Parties. I understand that this Agreement contains a promise not to sue the Released Parties and provides for a release and indemnity for all Claims.

Intending to be legally bound, I have signed this Agreement on December 12, 2018

 

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*
Third Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
How did you hear about BLOCS?
Please select one of the following:*
Drive By
Internet
Local Paper
Radio
Word of Mouth
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*

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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver and  Rock Gym Pro