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Shuswap Gym of Rock Inc.
WAIVER FORM

Release of Liability, Waiver of Claims, Assumption of Risk and Indemnity Agreement ("the Agreement")


 


Please note that by signing the Agreement, you waive the right to sue for any injury or damages, howsoever caused.

To: Shuswap Gym of Rock INC. and its directors, officers, employees, representatives and agents (collectively called the “Company").

I hereby sign the Agreement on behalf of myself, my personal representatives, heirs and assigns.  I acknowledge and agree that participating in or observing the activities sponsored and/or offered by Company including but not limited to indoor rock climbing, top roping, lead climbing, auto belaying and bouldering (the “Activities”), has inherent risks that may cause serious injury or death.  The inherent risks include but are not limited to:

 

  1. Injuries or death resulting from falls of persons who may come into contact with me;
  2. Injuries or death resulting from falls in which I may come into contact with other persons, walls, structures, ropes, the ground and/or other objects; 
  3. Injuries or death resulting from acts or omissions, negligence, error or lack of adequate training by you, Company or a third party; or
  4. Injuries or death resulting from the failure or negligent misuse of the facility, climbing walls, or any equipment of Company.


I fully understand the inherent risks associated with my participation in or observing of the Activities and I ASSUME COMPLETE RESPONSIBILITY and liability for those risks and for the injuries that may occur as a result of these risks, EVEN IF injuries occur in a manner that is NOT FORSEEABLE at the time I sign the Agreement. I realize that by voluntarily assuming the risks involved, I will be SOLELY RESPONSIBLE for any loss or damage I sustain, including PERSONAL INJURIES to me, damage to my property, or damages arising out of my death.

COMMUNICABLE DISEASES INCLUDING COVID-19
In consideration of being allowed to participate in activities at the Shuswap Gym of Rock, the undersigned acknowledges, appreciates, and agrees that:

 

  1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,
  2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
  3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
  4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the Company, its officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

By signing this document, I attest that every time I enter the Shuswap Gym of Rock, all members of my household and I:

  1. Are not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell;
  2. Have not traveled internationally within the last 14 days;
  3. Have not traveled to an area in Canada that is highly impacted by COVID-19 in the last 14 days;
  4. Have not been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19 or other communicable disease;
  5. Have not been diagnosed with Coronavirus/COVID-19 or other communicable disease and not yet cleared as noncontagious by local public health authorities; and
  6. Are following all medical health authority recommended guidelines, including those produced by the BC CDC, Health Canada, CDC, and WHO, as much as possible and limiting our exposure to Coronavirus/COVID-19 and other communicable diseases.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I agree that by signing the Agreement, I waive the right to sue for any injury or damages, howsoever caused, as a precondition to my participation in all Activities.  In further consideration of Company permitting me to participate in the Activities, I agree that I will be strictly bound by the terms of the Agreement.

I AM 19 YEARS OF AGE OR OLDER, AND I HAVE READ AND UNDERSTAND THE AGREEMENT. I UNDERSTAND THAT THE AGREEMENT CONTAINS A PROMISE NOT TO SUE COMPANY AND THAT IT CONSTITUTES A RELEASE OF LIABILITY AND AN INDEMNITY FOR ALL CLAIMS.

August 10, 2022

First Participant/Spectator Name

First Name*

Last Name*

Phone*
First Participant/Spectator Date of Birth*
First Participant/Spectator Signature*
Second Participant/Spectator Name

First Name*

Last Name*
Second Participant/Spectator Date of Birth*
Third Participant/Spectator Name

First Name*

Last Name*
Third Participant/Spectator Date of Birth*
Fourth Participant/Spectator Name

First Name*

Last Name*
Fourth Participant/Spectator Date of Birth*
Fifth Participant/Spectator Name

First Name*

Last Name*
Fifth Participant/Spectator Date of Birth*
Sixth Participant/Spectator Name

First Name*

Last Name*
Sixth Participant/Spectator Date of Birth*
Seventh Participant/Spectator Name

First Name*

Last Name*
Seventh Participant/Spectator Date of Birth*
Eighth Participant/Spectator Name

First Name*

Last Name*
Eighth Participant/Spectator Date of Birth*
Ninth Participant/Spectator Name

First Name*

Last Name*
Ninth Participant/Spectator Date of Birth*
Tenth Participant/Spectator Name

First Name*

Last Name*
Tenth Participant/Spectator Date of Birth*
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 information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's 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.
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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