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This statement requires each participant to verify that they are medically fit to climb.

Medical Fitness: Participants understand that activities at height are physically demanding, where physical fitness is a necessity and that by being in attendance you state you are in good physical health and capable of safely meeting the needs for medical fitness.

         — Weight Limits: Participants must weigh between 130 and 310 lbs. with all of their equipment and tools on. 

         — Contraindication: A condition which makes participation within a training event potentially inadvisable. A contraindication may be absolute or relative. Certain medical conditions are definite contraindications to safe and effective work at height. These conditions include, but are not limited to, the following: alcohol or drug dependence, diabetes, high or low blood pressure, epilepsy; fits; blackouts, fear of heights, vertigo; giddiness; difficulty with balance, heart disease; chest pain, impaired limb function, musculoskeletal issues, e.g. bad back; strains; sprains, obesity, and psychiatric illness.

         — A pre-participation physical release from a doctor or licensed health care provider may be required by your employer if you have an unfavorable medical condition. Please discuss privately and concerns you may have with the Optimum instructional staff member prior to any practical training activity. It is your responsibility to fully disclose any health issues or medications that are relevant to participation in the training.

I verify that I am medically fit to climb

I Agree

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*
Parent or Guardian's Email Address

Email*

Confirm Email*
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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