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CLIMB LAFAYETTE

ASSUMPTION OF RISKS, RELEASE AND INDEMNIFICATION AGREEMENT

The listed Participant(s) acknowledges and agrees to the following:

  1. Assumption of Risks.  Activities in which the Participant may participate (and/or be a spectator of) in the facilities owned or operated by Climb Lafayette (a d/b/a of Route to the Top LLC, referred to herein as "Climb Lafayette") or Landlord Superior Structures, including but not limited to indoor rock wall climbing, are potentially hazardous activities.  The Participant has been informed that he or she should not participate in any of the same without proper equipment and experience, and, even as a spectator, he or she must remain in complete awareness of his or her surroundings.  The Participant hereby assumes all anticipated and unanticipated risks associated with partaking in or being a spectator of any of the same activities.  These risks include, but are not limited to: falls, collisions (with people, objects or structures), being struck by other participants or objects, equipment failures (including any equipment supplied by Climb Lafayette, such as hand holds, harnesses and ropes), and the aggravation of preexisting injuries or conditions of the Participant's, all of which may or may not be caused by the negligence of other participants or Climb Lafayette, and all of which could result in sever injury and possibly paralysis or death.  Climb Lafayette and its managers, members, agents, employees and staff cannot and do not guarantee the Participant's safety.
     
  2. Release and Indemnification.  In consideration for the use of Climb Lafayette's facilities and/or equipment, the Participant, on his or her own behalf and on behalf of his or her heirs, executors, administrator, assigns and other representatives (collectively, the "Indemnifying Parties"), hereby agrees to release, indemnify and hold harmless Climb Lafayette, its managers, officers, members, affiliates, employees, promoters, contractors, volunteers, other participants and agents (collectively, the "Indemnified Parties") from any and all claims, losses, damages or demands, of any nature, to the full extent allowed by law, which any of the Indemnifying Parties may now or hereafter have against any of the Indemnified Parties, resulting from any personal injury, property damage, death or any other damage arising out of or in any way related to Participant's use of Climb Lafayette's facilities and/or equipment, including any of the same resulting from the negligence of the Indemnified Parties.
     
  3. Representations of Participant.  Participant hereby represents that he or she:

    A. is in good health and has no physical limitation that would prevent his or her safe use of Climb Lafayette's facilities and/or equipment;

    B. will abide by all rules regarding use of the facilities and equipment as provided in writing by Climb Lafayette (including the posting of signs in the facilities) or orally; and

    C. has read this agreement in its entirety and understands the legally binding nature and effect of the same.
     
  4. General.

    A. This agreement will be construed in accordance with the laws of the state of Indiana, without regard to its conflict of laws principals.

    B. Any action or claim arising out of related to this agreement will be brought solely in the courts located in Tippecanoe County, Indiana.

    C. In the event Climb Lafayette incurs any attorney's fees, court costs, or other expense to enforcement this agreement, it will be entitled to recover the same from Participant.

    D. To the extent any provision of this agreement becomes or is declared by a court of competent jurisdiction to illegal, unenforceable, or void, this agreement shall continue in full force or effect without such provision to the extent the same is deemed illegal, unenforceable or void.

    E. The obligations and provisions herein shall continue in perpetuity and apply to all occasions of future use of Climb Lafayette's facilities and/or equipment by Participant.

    ​F. Any photos/videos taken of the participant or participant’s property may be used by Climb Lafayette for publications in print and/or electronically.  Such use of photos/videos may be used with or without name for any lawful purpose including publicity, illustration, ads, and Web content.

 

Today's Date: April 28, 2024

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

First Name*

Last Name*

Emergency Contact's Phone Number*
Legal Guardian Acknowledgement. By signing this agreement, as the parent or otherwise legal guardian of the Participant, I acknowledge that I have read and understand the agreement in its entirety and agree to be bound by all of the terms contained therein. I understand, as further described in the agreement, that (1) all related risks, whether known or unknown, are hereby assumed by myself; (2) all related claims myself of the Participant may now or later have are hereby waived; and (3) I will indemnify and hold Climb Lafayette harmless from any and all related third party claims.


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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