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To be completed by participant on completion of the safety orientation at a CityROCK facility.

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

Participant

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

 

CityROCK Safety Orientation 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 the safety orientation: 

  1. Fitting the harness correctly to your body.
  2. Connecting the auto-belay carabiners correctly at correct point on harness.
  3. Check the carabiners are correctly locked through a squeeze test.
  4. Applying safe bouldering etiquette by down climbing, landing correctly and spotting in certain situations.

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

I have read and understood all the gym 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 Participant 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 Participant 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

First Participant's Name

First Name*

Last Name*
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*
Parent or Guardian's Email Address

Email*
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Staff to complete

Staff Name *

Date of orientation *
I am confident that I covered everything in the safety orientation.*
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 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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