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You may have seen in our initial COVID-19 closure announcement that we are still paying our employees as much as possible during this time. We are a small, locally owned business employing people from the London area; they along with our members (you!) are the community that helped build this gym.

While we understand that this may not be an option for all of you, we ask those of you who are financially able to stick with us in these difficult times. For those who wish to donate their membership amounts, here are your options:

  • Prepaid Members can opt to not have their membership extended and then purchase a new one when it expires.
  • EFT Members can donate their credit towards gym operating costs. You can also either give us consent to keep billing you at your regular monthly rate, or a custom amount of your choice until we reopen. If you choose to keep being billed every month, consent can be withdrawn at a later date by emailing kevin@junctionclimbing.com.

For tracking and accounting purposes, you must self-identify and provide consent to donate your membership - please use the below form to do so. If you are unable to donate your membership, you do not need to do anything!

Thank you so very much for your support.

First Member's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Member's Date of Birth*
Parent's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Membership Donation Options
Please choose your choice of membership donation. If you have chosen to keep being billed every month, consent can be withdrawn at a later date by emailing kevin@junctionclimbing.com.*
I am a PREPAID member and consent to my membership not being extended.
I am an EFT member who would like to donate ONLY my credit. Please do not charge me anything else until Junction reopens.
I am an EFT member who would like to donate my credit AND consent to being charged my regular monthly rate until Junction reopens.
I am an EFT member who would like to donate my credit AND consent to being charged a custom amount until Junction reopens.

If you chose to be charged a custom amount, please enter how much you wish to be billed here.


Parent's Name

First Name*

Middle Name

Last Name*
Parent's Date of Birth*
Parent'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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