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BOULDERZ CLIMBING CENTRE INC.
Participant Agreement, Waiver & Release Form

AGREEMENT, WAIVER & RELEASE

In consideration for being permitted by Boulderz Climbing Centre to observe/and or participate in, Rock Climbing, and Bouldering or any other service provided, Camps on and off the premises, general use of its gym facilities, lockers, washrooms, change rooms, belay equipment, ropes, harnesses, climbing shoes, grigris, bouldering zones and top out areas, top rope and lead climbs, mezzanine, and any other facilities in the gym provided by Boulderz Climbing Centre, hereinafter referred to as the facility. I hereby waive, release, and discharge any and all claims for damage for personal injury, death or property damage which I may have, or which may hereafter accrue to me, as a result of participation in said activity, in the facility. This agreement, waiver and release includes but is not limited to the waiver and release of any claims that I may have or may in the future have as a result of any illness or illnesses that I may contract, including COVID-19, or resultant death, from attending at the facility, participating in activities at the facility or supervising or viewing activities at the facility. For greater certainty, I assume any and all risk that I may contract an illness, including COVID-19, while at the facility or a Boulderz Climbing Centre event, notwithstanding reasonable steps and precautions taken by the Centre to prevent or mitigate the risk of such illness or illnesses. I expressly waive any right that I may have to make a claim for damages or other relief in the event that I contract such illness or illnesses and expressly release the Centre from such claims. This release is also intended to discharge in advance Boulderz Climbing Centre shareholders, directors, officers, employees, agents, representatives, independent contractors, subcontractors, sponsors, successors, representatives and assignees, from any and all liability arising out of or connected in any way with my participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is understood that this activity involves an element of risk and danger of accidents and knowing those risks (which include among other things: falling off the wall; loose and/or damaged artificial holds; rented equipment failure; falling to the ground, on other users, or being fallen on by other users; abrasions from the walls, ropes, pads, or the floor; equipment failure; belay and/or belayer failure; climbing out of control or beyond ones personal limits; the negligence of other climbers, visitors, participants, or other persons who may be present; muscular skeletal injuries and/or over training: head injuries; or my own negligence) I hereby assume those risks. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns. I agree to indemnify and to hold the above person or entities free and harmless from any loss, liability, damage, cost, or expense which they may incur as the result of my death or any injury or property damage that I may sustain while participating in said activity. I understand that wearing a helmet does not eliminate the danger of rock climbing but that in some instances it can reduce the risk of permanent injury or death. I acknowledge that Boulderz Climbing Centre does not require participants to wear helmets but has them available for all participants at no cost and that it is my responsibility to ask for a helmet if I choose to wear one. By executing this Agreement, Waiver and Release I acknowledge that I am not under the influence and/or have not consumed any alcohol, drugs or any other substances or medication which may impair my ability to engage in and participate in any of the activities offered at the facility.


BELAYING AGREEMENT AND SAFETY CHECK

When I learn or demonstrate to Boulderz Climbing Centre how to belay, if applicable now or at a future date, I recognize that belaying is a dangerous activity, and assume all responsibility for learning accurately how to perform this activity. I have read and initialed the “Agreement, Waiver & Release component” and I understand the nature of the sport I am engaging in. I will abide by current and future Boulderz Climbing Centre policies and the rules of the facility. I recognize that the definition of belaying is to secure the climber, and I will do so in accordance with Boulderz Climbing Centre policy standard procedures and as directed by staff. I also take responsibility for making sure that any belayer or climber with whom I participate in this activity is proficient in
these skills, and Boulderz Climbing Centre will not be responsible for poor judgment made by a belayer.

I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER, AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND BOULDERZ CLIMBING CENTRE AND I SIGN IT OF MY FREE WILL.


HEALTH ATTESTATION AND AGREEMENT

By signing below, the Participant (named below) attests that the Participant:

  1. Will not visit Boulderz Climbing Centre while having any symptoms of Covid-19, flu, or other contagious illness;
  2. Will notify Boulderz Climbing Centre staff and leave the facility immediately if any symptoms of Covid-19, flu, or other contagious illness become apparent;
  3. Will not visit Boulderz Climbing Centre while knowingly having Covid-19, flu, or other contagious illness;
  4. Is following the laws, recommended guidelines, and protocols issued by the Government of the Province in respect of Covid-19; and
  5. Will follow the guidelines and protocols mandated by Boulderz Climbing Centre in respect of Covid-19.

 

Today's Date: December 2, 2021

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*
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

Emergency Contact's 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.
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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