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Informed Consent for Minors and their Parent

This is an informed consent form for minors, which identifies risks of participating in a Weber State University (“WSU”) activity or program, and a consent form for parents/guardians. 

Parent or Guardian, read and sign this section:  I have been informed of the nature of the Activity, listed below, which my minor child wishes to participate in.  I recognize that the Activity may involve moderate to strenuous physical activity and may cause physical and or emotional distress to participants.  I state that my minor child is free from any known heart, respiratory or other health problems that could prevent her or him from safely participating in the Activity.  I consent to the participation of my minor child in the Activity.

ACTIVITIES: Activities of the Technical Training Center include but are not limited to the following: the use of roped (toprope, auto-belay, lead climbing, rappelling and rigging) climbing walls, bouldering areas, outdoor walls and other training equipment. Participation in activities or events including gear demonstrations, clinics, training, rappelling, remote indoor climbing, courses, classes and other activities and use of facilities and equipment at the Technical Training Center.

Climbing, bouldering, rappelling and rigging at the Technical Training Center
From date of signing below until the following 30th of June

 

CONSENT

Consent is expressively given, in the event of injury, for any emergency aid, anesthesia, and/or operation, if in the opinion of the attending physician, such treatment is necessary.

 

Participating minor child, read and sign this section:  I desire to participate in the Activity described above.  I agree to familiarize myself with the Activity and what is required, rules of conduct and safety equipment. I agree to follow proper operating procedures including safety procedures as outlined by the Activity leader, plus any directions given by WSU personnel.  I agree to follow the rules of conduct and use the provided safety equipment.

 

Today's Date: April 21, 2024

First Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Signature*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Signature*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Signature*
Parent or Guardian's Email Address

Email*
Check to receive information, news, and discounts by e-mail.
Email me a copy of this document.
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*
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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