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10 Eunos Rd 8, #01-205 SingPost Centre (Enrichment Zone, Singapore 408600

THIS DOCUMENT IS A LEGALLY BINDING AGREEMENT. BY SIGNING THIS AGREEMENT YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTOOD AND ACCEPTED THE TERMS ANDCONDITIONS STATED IN THIS AGREEMENT. YOU FURTHER ACKNOWLEDGE AND AGREE THAT YOU ARE WAIVING YOUR RIGHTS TO BRING ANY COURT ACTION TO RECOVER COMPENSATION OR OBTAIN ANY OTHER REMEDY FOR ANY INJURY TO YOUR SELF OR YOUR PROPERTY.

ACKNOWLEDGEMENT: I acknowledge that there are significant elements of risk associated with the height activities (sport of rock climbing and similar activities provided by Boulderworld. I further acknowledge the nature and extent of the risks inherent in the height activities and the use of the facilities. I acknowledge that there are possible risks associated with the use of the facility, and that other unknown and unanticipated risks may result in injury, illness, or death.

BoulderWorld Pte Ltd (“BW”) reserves the right to use any photograph/video taken within the premises of the gym or at any organized or sponsored programme/event, without the expressed written permission of those included within the photograph/video. OS may use the photograph/video in publications or other media material produced, used or contracted by BW including but not limited to: social media, brochures, invitations, newspapers, magazines, presentations, websites, etc.

RELEASE, ASSUMPTION OF RISK AND RESPONSIBILITY: In consideration of, and in recognition of the inherent risks of the activity associated with the use of the facility, I, and/or on behalf of any minor children for which I am responsible for, agree, on behalf of myself, my/our heirs, representatives, successors, executors, administrators and assigns, to hereby release, waive, discharge and agree not to sue its officers, directors, shareholders, agents and employees, for any and all claims or demands, obligations and/or causes of action of any nature whatsoever which I may have against its officers, directors, shareholders, agents and employees, on account of any personal injury, property damage, death or accident of any kind, arising out of or in any way connected with use of the facility or equipment, whether my/our use is supervised or unsupervised and I/we agree to indemnify and hold harmless the persons or entities mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of my/our actions.

I further certify, acknowledge and agree on behalf of myself and/or any minor children for which I am responsible, that:
I am (we are) physically and mentally capable of participating in the activity and/or use the equipment. I/we assume responsibility for and voluntarily assume the risks for any personal injury, death and related expenses involved with this activity. I/we assume responsibility for damage to my/our personal property, and I/we assume the risks for accidents or injury caused by the negligence of my fellow climbers. Further, I declare that all information given in this form is true and correct to the best of my knowledge and belief.

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. 

 

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*

Phone*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*

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

First Name*

Last Name*

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

First Name*

Last Name*

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

First Name*

Last Name*

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

First Name*

Last Name*

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

First Name*

Last Name*

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

First Name*

Last Name*

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

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
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*

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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