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Peak Experiences, Inc.
Assumption of Risks

Each person signing below attests that they have viewed the Bouldering & Orientation video provided by Peak Experiences as part of this Assumption of Risks form, and all questions about the activity, gear, or Peak Bouldering & Orientation video will be brought to a Peak Staff member prior to participating. 


I, the undersigned Participant, desire to participate in, and (if Participant is a minor, 17 years of age and younger), I, the parent/legal guardian of the Participant, grant permission for the Participant to participate in, the following rigorous physical activities (the “Activities”) and/or use the following climbing, fitness and adventure equipment (the “Equipment”) owned and/or provided by Peak Experiences, Inc. and/or Passages Adventure Camps (collectively “PEAK”) included but not limited to:

  • Indoor climbing wall, boulders, ropes, climbing gear and auto-belay devices;
  • Day and overnight camps and other programs involving activities and gear for kayaking, stand-up paddling, rappelling, zip-lining, slack lining, rock climbing, bouldering, wilderness survival skills, swimming, mountain biking, giant swing, bouncy house and other rigorous activities;
  • High ropes course, consisting of a series of elements made of cables, ropes, planks and trapeze bar located more than 30 feet above the ground;
  • Field games, adventure trips and challenge activities; and
  • Fitness equipment and activities including, but not limited to, TRX suspension training, balance balls and platforms, kettle balls, medicine balls, cardiovascular training, weight training equipment and yoga.

Each person signing below acknowledges that using the Equipment and participating in the Activities are inherently dangerous, and involve strenuous physical activity and a risk of severe injury or death.  Inherent risks are risks that cannot be eliminated completely without changing the challenging nature of the activity regardless of the care and precautions taken by Peak.  Inherent risks include, but are not limited to, slipping or falling off the Equipment, hitting or swinging into hard, rough or pointed surfaces and protrusions, becoming entangled in the Equipment or other apparatus, spinning or loose climbing holds or holds that break or dislodge during use, colliding with or being injured by other participants or dropped items, being exposed to natural forces, such as wind, water, mud, lightning, etc., or using the Equipment improperly.  Resulting injuries may include, but are not limited to, cuts, abrasions, rope burns, pinching, bruises, paralysis, sprains, broken bones, facial injuries, facial and head injuries, blunt force trauma, and other severe injuries or death. 


Participant must notify Peak if Participant becomes aware of any unsafe condition related to any Equipment or any of the Activities, and must discontinue use of such Equipment or stop participating in the Activities until the condition can be corrected.  Participant must also follow all policies, rules and directions of Peak staff.  Each person signing below further acknowledges that Participant’s failure to abide by these provisions can result in injuries described above. 


Each person signing below also understands that (i) wearing a helmet while using the Equipment and/or participating in the Activities is highly recommended and that if requested, Peak will provide a helmet to Participant free of charge, and (ii) Participant may seek guidance from Peak staff regarding the Equipment or the Activities at any time.  


If the participant is a minor, the parent/legal guardian certifies that he or she has discussed with the Participant the inherent dangers and risks of using the Equipment and participating in the Activities.  


Each person signing below certifies that Participant (i) does not suffer from back, leg, arm, hand or other bodily injuries, heart ailments, dizziness, vertigo, or any other medical condition that may affect Participant’s ability to participate in the Activities or use the Equipment, nor has Participant been advised to limit his or her activities in any manner due to medical advice, (ii) will not be under the influence of an drugs, alcohol or other substances which may impair the Participant’s judgment and/or physical capabilities, and (iii) will follow all policies, rules and directions of Peak staff.  


Each person signing below hereby certifies that he/she understands the nature and extent of the risks in using the Equipment and/or participating in the Activities, and to the fullest extent permitted by Virginia law, hereby assumes all risks involved in using the Equipment and/or participating in the Activities.  Each person signing below agrees that such Assumption of Risks is voluntary and based upon each person’s own choice to use the Equipment and/or to participate in the Activities, and further agrees that he/she will be solely responsible for any injuries, losses, damages or death sustained as a result of using the Equipment and/or participating in the Activities.  


The laws of the Commonwealth of Virginia shall govern the rights and obligations of the parties hereto and the interpretation, construction and enforceability of this document.  I further agree that if any portion of this Assumption of Risks is construed to be invalid or unenforceable, the remainder of this document shall not be affected and shall be given full force and effect without regard to the invalid and/or unenforceable portion.  


A signed electronic, faxed or scanned copy of this document shall be deemed an original. This document is effective immediately upon acceptance by Participant and shall continue in effect for all future Activities of Participant.  Peak reserves the right to revise this document and seek Participant’s acceptance of any new document.  


Each person signing below grants PEAK the right to use for promotional purposes the participant’s photo, video or audio taken in any PEAK activity.  


Rules for the Gym:

ASSUMPTION OF RISK: All climbers must have a current, signed Assumption of Risks on file with Peak Experiences.

  1. Before climbing, always double check both the climber and belayer’s harness, knot, belay device set-up, anchor (if applicable), and use proper commands at all times.
  2. Never take your brake hand off of the rope no matter which belay device you are using.
  3. You may use your own UIAA approved belay device and locking carabiner with our ropes. You may not belay with hitches or figure 8 devices.
  4. You must tie directly into your harness per manufacturer’s directions.
  5. We recommend you anchor in on your belay loop. If you choose to anchor in from behind, it must be to a load bearing loop.
  6. Always stand while belaying and lower climbers slowly and in a controlled manner.
  7. Bouldering and traversing are not allowed over gravel flooring at our Midlothian facility.
  8. Our Challenge Course platform may only be used during challenge course activities when supervised by a staff member. Same rules apply with rappelling.
  9. Wear closed toed shoes while climbing, no bare feet on the walls or holds.
  10. Don’t swing on our ropes.
  11. Respect others and use only appropriate language.
  12. Save energy by walking in the gym instead of running.
  13. Cool route? No kidding, but let’s not hog it.
  14. Wearing shoes at all times while in the facility is recommended.

TESTING:

  1. Before top rope belaying at Peak Experiences, you must pass our Top Rope Belay test.
  2. You must pass a separate test for each type of device you wish to use.
  3. Before Lead Climbing or Lead Belaying, you must pass our Lead Climb and/or Lead Belay Test.
  4. Before using our Auto Belays, you must pass our Auto Belay Test.
  5. Before Bouldering, you must watch our Orientation & Bouldering instructional video.

You must retest on all devices and skills if you check in at our facilities less than 1 time every 6 months. So don’t let that happen. Keep climbing!

I have read and understand these rules. 


All participants 7 years of age and older must also sign for themselves. For those 6 years of age and under, the parent or legal guardian may sign.

Date: April 24, 2024

Please select all parties that will be present in the facility. Anyone entering a Peak facility is considered a participant and must complete this form.
AdultMinor(s)Adult and Minor(s)
1 Minor2 Minors3 Minors4 Minors5 MinorsMore Minors6 Minors7 Minors8 Minors9 Minors10 Minors
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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*
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

First Name*

Last Name*

Emergency Contact's Phone Number*
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 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.


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