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ACKNOWLEDGEMENT AND ACCEPTANCE OF RISKS AND RESPONSIBILITIES

WARNING: Any activity or any sport associated in an outdoor bouldering area, as well as in any material, equipment and in regimes of physical conditioning relative to it or even the «slackline» activity (below called "activity") contain elements of considerable risks. Although we took responsible measures to supply you with appropriate instructions and/or with competent instructors to allow you to take advantage of an activity for which you are not maybe skillful, we wish to remind you that this activity is not without risks. Indeed, certain risks cannot be eliminated without destroying the unique character of the activity. The elements which contribute to make this activity unique can cause the loss or the damage of your equipment, or accidental wound, a disease or, in extreme cases, permanent trauma or death. We do not want to frighten you nor to reduce your enthusiasm towards the activity, but we believe that it is important that you beforehand know what to expect and that you are warned and prevented of the inherent risks.

RECOGNITION OF THE RISKS

  1. The fact of sliding, of stumbling, to fall or to crash in a painful way during the use of the installations or the material, the climbing walls, the pits of reception, floors under the areas of climbing, areas of training, sanitary installations, areas of relaxation;
  2. The misuse of the material or the installations, or still the failures of the material;
  3. The unforeseen falls due to an inadequate positioning, a badly made movement or of in an unexpected loss of control;
  4. My health, my physical strength, my coordination, my sense of the balance and my capacity to follow or to give directives during the escalation or during the training risk not to be enough to allow me to practise in complete safety the sport of outside escalation;
  5. Fatigue, shiver and\or intoxication, which can reduce my/our response time and to increase the risk of accident;
  6. Caused grazes the material or the structures;
  7. The presence, the actions or the falls of the other participants;
  8. The risks inherent to the weather conditions, especially the rain, the cold, the wind, the sun, the lightning or the blackness.

I understand that the description of these risks is not complete and that other unknown or unforeseen risks can cause wounds, disease or death.

I also make a commitment to play an active role in the management of these risks, by adopting a preventive attitude towards me, as well as towards the other people surrounding me. I release the NOMAD BLOC Climbing Center and the Olympic Park from all liability in the event of accident or damage of any kind whatsoever suffered during or in connection with the activity.

HEALTH AND PHYSICAL STATE
I give evidence that I am in good physical condition and that I have no health problem preventing me from participating in the activities of the bouldering gym NOMAD BLOC. I make a commitment to mention any physical or mental condition which could have an incidence on my safety or that of the others. I make furthermore a commitment not to participate in the activities of the bouldering gym NOMAD BLOC with the weakened faculties.

ACCEPTANCE OF THE RISKS
I accept the risks of physical hurts, accidents and/or diseases, including in particular sprains, muscular and/or ligamentary tears, cracks, tiny fissure or fractures, eye illness, cuts, wounds, scratches, grazes and/or the bruises, the dehydration, the lack of oxygen, the exposure to height and/or height sickness, sunburns, insolation, heat stroke and/or exhaustion of in the heat, traumas to the head, to the neck and/or to the vertebral column, the lung problems, the nervous shocks, the paralysis and/or the death.

I ACCEPT THE FULL RESPONSIBILITY regarding the CHOICE OF A PERSON IN CHARGE TO ASSURE ME AND TO WATCH MYSELF.

COMMITMENT TO RESPECT RULES AND REGULATIONS
I assert having understood and I agree to respect rules and regulations of the bouldering gym NOMAD BLOC, whose copy is posted in the bouldering gym NOMAD BLOC. (A copy printed of the regulations is available on request.)

The bouldering gym NOMAD BLOC and his/her representatives or the Olympicreserve the right to refuse or to suspend the access right to the bouldering gym to every climber who demonstrates a dangerous attitude towards safety, or who does not respect rules and regulations of the Center of bouldering gym NOMAD BLOC.

WEARING OF A HELMET
I understand that the wearing of a helmet can reduce the risk of cranial trauma and I am personally responsible for my decision to wear a helmet or not. It is my responsibility for supplying my own helmet.

THEFT, LOSS AND BREAKING
I recognize that the bouldering gym NOMAD BLOC is not responsible for the loss, for the breaking or for the theft of personal objects.

PHOTOS AND PROMOTIONAL MATERIALS
I authorize by the present the bouldering gym NOMAD BLOC to use photos as well as video material for advertising purposes without any compensation whatever it is.

COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, provincial, and local governments and federal and provincial health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. NOMAD BLOC has put in place many preventative measures to reduce the spread of COVID-19; however, NOMAD BLOC cannot guarantee that you or your child(ren) will not become infected with COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending NOMAD BLOC and that such exposure or infection may result in personal injury, illness, permanent disability, and death

I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Gym, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Nomad Bloc program.

I recognize to have read and understood the acknowledgement and the acceptance of the risks and the responsibilities above, I agree freely and completely to assume all the risks and the dangers mentioned above and I make a commitment to respect rules and regulations of the bouldering gym NOMAD BLOC.

In the event that I sign this document for a minor or minors, I hereby declare that I am the legal guardian of the minor participant(s). I also declare that I have informed the minor participant(s) about the content of this acknowledgement and acceptance of risks and I confirm that they agree with its terms and conditions. I sign this acknowledgement and acceptance of risks of the minor participant(s) on their behalf(ves), and I consent, with full knowledge of the risks and conditions outlined above, that the minor participant(s) participate(s) in the activities of NOMAD BLOC.

Today's Date: April 20, 2024

First Participant's Name

First Name*

Last Name*

Phone*
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*
Participant's 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
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A signed copy of this waiver will be sent to the email address you provide.
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*

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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