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To be completed by participant on passing their Top Rope Belay Test at CityROCK. Participants to be 13 years or older.


DISCLAIMER AGREEMENT

Between The Indoor Climbing Centre Pty LTD T/A CityROCK, hereafter referred to as

CityROCK

And The Climber, or any person entering CityROCK, hereafter referred to as the

Climber

CityROCK and the Climber have entered into an agreement in terms whereof CityROCK has allowed the Climber to make use of its facilities on the terms and conditions below.

 

CityROCK Top Rope Climbing Agreement

I acknowledge the fact that there is an inherent danger in the sport of rock climbing, including, but not limited to injury or death, and I understand that no amount of care, caution, instruction or expertise can eliminate this inherent danger completely.

I confirm that I will pass CityROCK's top rope test before top rope climbing or belaying in the gym.

The following are key to safe climbing.

  1. Tying in properly with a double figure eight.
  2. Connecting belay device correctly at correct point on harness.
  3. Demonstrate how to belay correctly.
  4. Buddy check.
  5. Clear verbal commands, verbal and visual communication with your climbing partner.
  6. Use only the preloaded device on the rope, do not load your own device.

I understand that learning to climb at CityROCK does not qualify me to climb outside.

I will ensure that my belayer is known to me personally to be a safe belayer and has also passed the CityROCK Top Rope Belay Test.

I have read and understood all the gym rules, including, but not limited to, the top rope climbing rules, and I agree to abide by them. I understand that if I breach any of the rules CityROCK reserves the right to permanently revoke my privileges and deny me access to their facilities.

 

I Agree

 

WAIVER

The Climber acknowledges that the activity in which he/she participates in by its very nature dangerous and carries inherent risks. These risks could cause him/her to sustain bodily injury or death and/or suffer damages and the Climber waives any claim however arising against CityROCK or its members, employees or any third party.

DISCLAIMER

The Climber makes use of CityROCK's facilities at entirely his/her own risk. The Climber agrees that CityROCK will not be held liable and/or responsible for any loss, injury, damages, death, and/or compensation of whatsoever nature and howsoever arising as a result thereof.

We will not be responsible for, and shall not pay for, any loss, damage or theft of items left unattended.

I Agree


Please select who will be participating...
AdultAdult and a Minor
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First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Information

Id Number of participant/guardian

Contact Number of participant/guardian *
First Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Emergency Contact

Emergency Contact Name and Surname *

Emergency Contact number *
Relation to participant*
Staff to complete

Testing Staff Name *

Date of test *
I am confident that the participant is top rope climbing competent to climb at CityROCK.*
Yes
No
CityROCK branch *
Cape Town
Johannesburg
Pretoria
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*

Last Name*

Relationship*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Id Number of participant/guardian

Contact Number of participant/guardian *
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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