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Vertically Inclined Rock Gym Inc.
WAIVER RELEASE AND INDEMNITY. THIS IS A LEGAL DOCUMENT PLEASE READ THOROUGHLY.
Warning: By signing this form you relinquish your right to bring court action to be compensated for any injury or loss to yourself as well as the right of your personal representative to compensation for your death.
All boxes must be filled out in order to climb. Thanks! 

I understand that I will be required to present photo identification upon my first visit after the completion of this waiver in order to verify the information provided.

I Agree

Initials of parent if under 18 OR Initials of participant if greater than 18 yrs.


I, the Undersigned understand and acknowledge that I am aware of the risks associated with or related to the use of the climbing wall (including the risk of severe or fatal injury), to myself particulars of which include but are not limited to the following: 

(a) injuries resulting from falling and impacting climbing wall faces or the ground, including an object or objects resting on the floor;
(b) injuries resulting from activities such as climbing, belaying, rappelling, rescue systems and other rope techniques;
(c) injuries resulting from falling climbers or objects such as rope or climbing hardware;
(d) injuries resulting from the physical activity of the sport itself including but not limited to neck and back strains, muscle strains, muscle pulls, tendon and ligament damage as well as other typical athletic injuries or more serious injuries.

I voluntarily accept these physical risks.


I understand that by signing this document, I, my successors, heirs, assigns or personal representative waive the right to sue or otherwise claim against Vertically Inclined Rock Gym Inc. or its employees, volunteers, officials, sponsors, directors, employees, agents, coaches, instructors or independent contractors for any loss or damage connected with any property loss or personal injury that I sustain while participating in or preparing for any program or activity of the Vertically Inclined Rock Gym Inc. 

I further understand clearly that I, my successors, heirs, assigns and personal representatives waive the right to sue or otherwise claim against Vertically Inclined Rock Gym Inc. or its employees, volunteers, officials, sponsors, coaches, agents, directors, instructors or independent contractors if the loss or injury suffered results wholly or in part from the negligence of Vertically Inclined Rock Gym Inc., its employees, volunteers, officials, sponsors, coaches, agents, directors, instructors or independent contractors or from the negligence of any third party, including other participants in the programs.


I further agree to indemnify and save harmless Vertically Inclined Rock Gym Inc. employees, volunteers, officials, sponsors, coaches, agents, directors, instructors or independent contractors, from any and all actions, claims, demands, losses or suits of any nature resulting from and arising from out of my participation in any program in Vertically Inclined Rock Gym Inc. or my use of its facilities or from the participation of my infant child in any program in Vertically Inclined Rock Gym Inc. or from that child’s use of its facilities.

I acknowledge that I am of the full age of 18 years and that I have read and fully understood this agreement prior to signature.

 IN WITNESS WHEREOF I have executed this document at the city of Edmonton in the Province of Alberta this day of November 26, 2020.

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 email newsletters with information and offers from Vertically Inclined.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Photo Consent: I give permission to Vertically Inclined Rock Gym Inc and/or parties designated by Vertically Inclined Rock Gym Inc to photograph/video me or my child and use such photograph(s)/video(s) in all forms of media, for any and all promotional purposes including advertising, display, audiovisual, exhibition or editorial use.*
No
Yes
Where did you hear about Vertically Inclined?*
Internet/ Website
Pamphlet/ Leaflet
Media Advertising
Social Media
Groupon
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*

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.


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