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www.altitudegym.ca

35, Saint-Raymond Blvd., Gatineau, Québec, J8Y 1R5
Phone: 819-205-0959 Fax: 819-205-0960

PARTICIPATION AGREEMENT

Date: November 22, 2019

Waiver of liability, release of all claims, risk assumptions and indemnification agreement. By signing this, you give up certain legal rights including legal proceedings and lawsuits. 

RULES AND REGULATIONS

I understand that the rules and regulations given by the Altitude Gym and Clip ‘N Climb staff are important to ensure the safety of all participants, and must be respected.

Description of risks:

I acknowledge that the following describes some risks of rock climbing and the use of its infrastructures:

1. Slips, trips, falls or painful crashes while using the facilities or equipment, climbing walls, bouldering areas, landing pits, floors below climbing areas, bathroom facilities, or stairs. day month year

2. Injuries resulting from falling, including but not limited to, falling onto persons, falling and coming into contact with any walls, structures or ropes, or falling to the floor.

3. The presence, actions or falls of other participants. I understand that the description of these risks are not complete and that other unknown or unanticipated risks may result in injury, illness or death. 

I understand that the description of these risks are not complete and that other unknown or unanticipated risks may result in injury, illness or death.

SIGNATURES

THIS FORM MUST ALSO BE SIGNED BY A PARENT OR A GUARDIAN IF YOU ARE UNDER 18 YEARS OLD.

By signing this agreement, I give up all legal proceedings and lawsuits regarding Altitude Gym and Clip ‘N Climb.

I acknowledge that I have read this agreement and that I fully understand, appreciate and accept the physical risks associated with my child’s participation or mine at Altitude Gym. I confirm that the information I have provided is accurate and complete. 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First 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*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
HOW DID YOU HEAR ABOUT US?
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*

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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