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Climbing Gym Release of Liability and Assumption of Risk

Parental Consent Agreement

Participation Statement 

“The British Mountaineering Council recognises that climbing and mountaineering are activities with a danger of injury or death. Participants in these activities should be aware of and accept these risks and be responsible for their own actions and involvement,’’  

Association of British Climbing Walls - "All climbing activities have a risk of serious injury or death. Participants must recognise that even if they follow all good practice there may still be the risk of accident and injury. It is the responsibility of the participant to adhere to the conditions of use"

 

Parental Consent 

I am aware that bouldering and roped climbing are activities with a danger of personal injury or death.

I have understood the nature of the activities and accept the risk involved 

I confirm I am the parent or guardian of above names child and that I consent for him or her to take part in rope climbing and bouldering.

I consent to any emergency medical treatment deemed necessary in case of an incident

I have read the BMC booklet entitled "Young People - a Parents Guide"



 

Privacy and General Data Protection Regulations (GDPR) Policy

To comply with GDPR we are required to obtain your consent to collect and store your personal data. Boulder Central Ltd is the Data Controller. We require your data to ensure that you comply with the conditions of use of the centre. We will store your data securely and will not disclose it to any third party. At any time you can request a copy of your data free of charge. GDPR makes provision for you to request to have your data removed and erased. This is known as the ‘Right to erasure/ right to be forgotten’. When data is held for the establishment, exercise or defence of legal claims we have the right to refuse to erase the data. For this reason our insurers insist that we continue to hold your data for 3 years from the date of your most recent visit.

In the case of Under 18 years olds, this is extended to 3 years beyond their 18th birthday. If you make a written request for erasure of your data, this request will be logged and the data will be erased after the period stated above.

In order to be allowed to use the facilities and services provided by Boulder Central Ltd you are required to consent to our Privacy and GDPR Policy. Please initial here to give your consent
Parent:


I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS.  

Today's Date: May 12, 2024

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Medical Conditions/Disabilities

Medical Matters:


Medicines:

Allergies:
Gender:*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

Medical Conditions/Disabilities

Medical Matters:


Medicines:

Allergies:
Gender:*
Third Participant's Name

First Name*

Middle Name

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

Medical Conditions/Disabilities

Medical Matters:


Medicines:

Allergies:
Gender:*
Fourth Participant's Name

First Name*

Middle Name

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

Medical Conditions/Disabilities

Medical Matters:


Medicines:

Allergies:
Gender:*
Fifth Participant's Name

First Name*

Middle Name

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

Medical Conditions/Disabilities

Medical Matters:


Medicines:

Allergies:
Gender:*
Sixth Participant's Name

First Name*

Middle Name

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

Medical Conditions/Disabilities

Medical Matters:


Medicines:

Allergies:
Gender:*
Seventh Participant's Name

First Name*

Middle Name

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

Medical Conditions/Disabilities

Medical Matters:


Medicines:

Allergies:
Gender:*
Eighth Participant's Name

First Name*

Middle Name

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

Medical Conditions/Disabilities

Medical Matters:


Medicines:

Allergies:
Gender:*
Ninth Participant's Name

First Name*

Middle Name

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

Medical Conditions/Disabilities

Medical Matters:


Medicines:

Allergies:
Gender:*
Tenth Participant's Name

First Name*

Middle Name

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

Medical Conditions/Disabilities

Medical Matters:


Medicines:

Allergies:
Gender:*
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*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*

Middle Name

Last Name*

Relationship*

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

Medical Conditions/Disabilities

Medical Matters:


Medicines:

Allergies:
Gender:*
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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