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Climb Central Delhi Facility Waiver, Release of Liability, Assumption of Risk

  • PLEASE READ CAREFULLY AND APPROACH FRONT DESK IF YOU NEED HELP
  • PLEASE USE THE PHOTO ID THAT YOU CAN PRODUCE FOR VERIFICATION AT THE FRONT DESK


In consideration of the services of Climb Central Delhi, ClimbCentral India Private Limited, its subsidiaries, its officers, directors, shareholders, employees, agents, volunteers, participants and all other persons or entities acting in any capacity on its behalf (hereinafter collectively referred to as ‘‘Climb Central Delhi”), I hereby agree to release and discharge Climb Central Delhi on behalf of myself, my children, my parents, my heirs, representatives, successors, executors, administrators and assigns as follows:

Acknowledgement: I acknowledge that climbing and non-climbing related activities, and entry to /use of any of Climb Central Delhi’s services or facilities at this location, all other Climb Central Delhi locations, or any off-site locations, entails significant risks, both known and unknown, which could result in physical or emotional injury, paralysis, illness, death, or damage to myself, my property, or third parties. Such risks include, but is not limited to, falling and colliding into the walls or other obstacles, falling climbers, dropped items, rope abrasions, entanglement, equipment failure, broken and /or falling holds, loose holds, failure to follow proper and customary safety procedures, or the negligence of climbers, belayers, participants, spectators, users of the facility, third parties, and Climb Central Delhi.

Release, Assumption of Risk and Responsibility: I agree to accept and assume all of the risks, both known and unknown, existing in these activities and entry to /use of Climb Central Delhi’s services or facilities, even if it may result in injury, death, property damage or other loss. I acknowledge that participation is voluntary and I elect to participate in spite of the risks. To the fullest extent permitted by law, I voluntarily waive, release, discharge and agree to indemnify and hold harmless Climb Central Delhi from any and all liabilities, claims, demands, obligations and/or causes of action, for any injury, death, property damage or other loss, which may arise out of, or is in any way connected with my participation in these activities, or entry to /use of Climb Central Delhi’s equipment or facilities, whether such activities, entry or usage is supervised or unsupervised. I further agree to indemnify and hold harmless Climb Central Delhi from all liabilities or claims made by other individuals or entities as a result of my actions, or the actions of my children, my parents, my heirs, representatives, successors, executors, administrators and assigns.

I certify that myself and/or any minors for whom I am responsible, are physically and mentally capable of participating in the activities and to use the facilities. I declare that the information given in this form is true and correct to the best of my knowledge and belief. I agree to abide by the rules of the facility and give consent for my data to be used in accordance with Climb Central Delhi ’s data protection policies

I certify that I am agreeing to this document on my own behalf, and/or as the parent /legal guardian on behalf of the listed participant, with due authority to agree to the terms of this agreement on their behalf.  I agree that this document is a legally binding agreement and have had sufficient opportunity to read the entire document. 

I have read, understood and accepted the terms and conditions of this agreement.

 

First Adult's Name

First Name*

Last Name*
First Adult's Date of Birth*
First Adult's Signature*
Second Adult's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Adult's Date of Birth*
Adult ID information
Click to customize drop-down*

ID Number *

Issuing State / Country *
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:*
Phone Number

Mobile Phone *
Parent/Guardian (Adult) Email Address

Email*

Confirm Email*
We have a strict No-SPAM policy. By checking this box you allow Climb Central Delhi to send some useful information and discounts periodically. You can opt-out at a later date also.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Optional Information
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.


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/Guardian (Adult) Name

First Name*

Last Name*

Relationship*
Parent/Guardian (Adult) Date of Birth*
Parent/Guardian (Adult) 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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