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In consideration of the services of Boulder World Pte Ltd, Climb Asia Prgn Pte Ltd, Climb Asia Pte Ltd, all other subsidiaries, its officers, directors, shareholders, employees, agents, volunteers, participants and all other persons or entities acting in any capacity on its behalf (hereinafter collectively referred to as ‘‘Boulder World’’), I hereby agree to release and discharge Boulder World on behalf of myself, my children, my parents, my heirs, representatives, successors, executors, administrators and assigns as follows:

Acknowledgement: I acknowledge that climbing and non-climbing related activities, and entry to /use of any of Boulder World’s services or facilities at this location, all other Boulder World locations, or any off-site locations, entails significant risks, both known and unknown, which could result in physical or emotional injury, paralysis, illness, death, or damage to myself, my property, or third parties. Such risks include, but is not limited to, falling and colliding into the walls or other obstacles, falling climbers, dropped items, rope abrasions, entanglement, equipment failure, broken and /or falling holds, loose holds, failure to follow proper and customary safety procedures, or the negligence of climbers, belayers, participants, spectators, users of the facility, third parties, and Boulder World.

Release, Assumption of Risk and Responsibility: I agree to accept and assume all of the risks, both known and unknown, existing in these activities and entry to /use of Boulder World’s services or facilities, even if it may result in injury, death, property damage or other loss. I acknowledge that participation is voluntary and I elect to participate in spite of the risks. To the fullest extent permitted by law, I voluntarily waive, release, discharge and agree to indemnify and hold harmless Boulder World from any and all liabilities, claims, demands, obligations and/or causes of action, for any injury, death, property damage or other loss, which may arise out of, or is in any way connected with my participation in these activities, or entry to /use of Boulder World’s equipment or facilities, whether such activities, entry or usage is supervised or unsupervised. I further agree to indemnify and hold harmless Boulder World from all liabilities or claims made by other individuals or entities as a result of my actions, or the actions of my children, my parents, my heirs, representatives, successors, executors, administrators and assigns.

I certify that myself and/or any minors for whom I am responsible, are physically and mentally capable of participating in the activities and to use the facilities. I declare that the information given in this form is true and correct to the best of my knowledge and belief. I agree to abide by the rules of the facility and give consent for my data to be used in accordance with Boulder World’s Personal Data Protection Policy.

I certify that I am agreeing to this document on my own behalf, and/or as the parent /legal guardian on behalf of the listed participant, with due authority to agree to the terms of this agreement on their behalf.  I agree that this document is a legally binding agreement and have had sufficient opportunity to read the entire document. 

I have read, understood and accepted the terms and conditions of this agreement.

 

 

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.
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:*
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*

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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