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Individual Participant Waiver and Release Agreement

The undersigned in consideration for the right to participate in the below described activity (“Activity”) hereby agrees to this waiver and release.

I recognize that the Activity may have a risk of personal injury and/or damage to my property. This includes:

  1. Risks involved in physical activity. These activities may include walking, running, climbing, repetitive lifting, and other strenuous activity.  Physical activity may also include the risk of injury such as slips, falls, cuts, scrapes, lacerations, burns, sprains, strains, tears, concussion, fractures of bones, bleeding, bruising, hemorrhage, infection and discomfort such as pain, nausea, dizziness, or other illness or sickness.
  2. Risks involved in climbing and bouldering. These include but are not limited to falls from height and attendant impact with the floor or other surfaces, which may include the possibility of death, serious neck or spinal injury, complete or partial paralysis, and brain damage.
  3. Risk of equipment failure. Equipment used may malfunction, break, or fail, despite reasonable care, maintenance, and use even when properly used.

I hereby freely assume all risks which may be associated with or result from participating in the Activity including, but not limited to: travel to and from, instruction, participation, and competition.

I further agree to release the State of Utah, Weber State University (WSU), their officers, employees, agents, contractors and volunteers (“Releasees”) from any and all liability, claims, demands, actions, loss, claim, damage, injury, illness, or harm (“Claims”) to me of any kind or nature arising out of participation in the Activity including where Claims occur due to the negligence of Releases. 

Climbing, bouldering, rappelling and/or rigging at the Technical Training Center
From date 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.

I AM 18 YEARS OF AGE OR OLDER, HAVE CAREFULLY READ AND UNDERSTAND THE CONTENTS OF THE FOREGOING WAIVER AND RELEASE, AND I SPECIFICALLY INTEND IT TO COVER MY PARTICIPATION OR COMPETITION IN THE ABOVE DESCRIBED EVENT.

Today's Date: April 19, 2024

*If under 18 do not use this form, you must submit an informed consent signed by a parent or legal guardian.

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
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*
Third Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

W#
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*

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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