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Climbing, Bouldering and Abseiling are dangerous recreational activities, with inherent risk of injury. All participants, belaying, climbing and bouldering need to be able to accept personal responsibility for their actions. You are participating at your own risk.

The Participant acknowledges and agrees as follows:

1. Participation in the activities conducted by Northside Climb including but not limited to indoor/outdoor rock climbing,
absieling, and bouldering; involves a high level of risk of personal injury;

2. The Participant must listen to and follow all lawful directions provided by Northside Climb its employees, contractors and/or agents prior to, during and after engaging in the activities;

3. Northside Climb provides information and instruction prior to engaging the activities. The Participant acknowledges that engaging in the activities may require a degree of skill and will take
appropriate steps to learn safe techniques and the proper use and limitations of each piece of equipment required for the activities, as instructed by Northside Climb, prior to engaging in the
activities;

4. The Participant accepts full responsibility for the Participant’s level of fitness and any limitations as a result of the Participant’s physical condition and the participant’s response to any physical
exertions associated with the activities;

5. The Participant understands that the risks involved in engaging in the activities may result in injury or death;

6. The Participant accepts and assumes full responsibility and liability for the risks dangers and hazards of and the possibility of injury danger or death from, and in any way associated with
participation in the activities now and in the future;

7. Northside Climb, its employees, contractors and/or agents shall not be held liable for any injury, damage, loss, consequential loss, claim or demand whatsoever which may arise during, in
association with, participation in or traveling to or from the activities and the Participant hereby agrees to release, indemnify and hold harmless Northside Climb, its employees, contractors
and/or agents from and against all liability, claims, actions and demands of whatsoever nature arising out of any accident, injury, loss or illness which may befall the Participant during or as a
result of the Participant’s participation in the activities or whilst traveling to or from the activities including but not limited to claims in negligence, contract or breach of statute;

8. Should the Participant’s actions, present a danger or be of a reckless nature to Northside Climb, the Participant or other participants engaged in the activities, then Northside Climb
reserves the right to require the Participant to cease engaging in the activities and/or leave the premises from which the activity is being conducted immediately and the Participant will not be
entitled to a refund or recourse of any nature;

9. The Participant understands that this consent and indemnity is ongoing and will apply to all future occasions in which the Participant engages in activities provided by Northside Climb;

10. The Participant agrees to pay the full replacement cost of any equipment used whilst engaging in the activities which is wilfully damaged by the Participant or not returned by the Participant;

11. The Participant agrees that Northside Climb may take photographs of the Participant during the activities for Northside Climb use and promotional purposes. The photographs taken by
Northside Climb shall at all times remain the property of Northside Climb. The Participant waives any claim that the Participant may otherwise have in respect of the use of any
photographs taken by Northside Climb;

12. The Participant has completed the Medical Consent Form provided by Northside Climb and all information provided is true and correct in all respects; and

13. The Participant has read this document and fully understands and accepts the terms and conditions stated herein and acknowledges that this document will be binding upon the Participant, the
Participant’s successors and assigns.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's physical history
Does the Participant have a preexisting injury?*
No
Yes

If yes, please enter details below.

First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's physical history
Does the Participant have a preexisting injury?*
No
Yes

If yes, please enter details below.

Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's physical history
Does the Participant have a preexisting injury?*
No
Yes

If yes, please enter details below.

Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's physical history
Does the Participant have a preexisting injury?*
No
Yes

If yes, please enter details below.

Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's physical history
Does the Participant have a preexisting injury?*
No
Yes

If yes, please enter details below.

Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's physical history
Does the Participant have a preexisting injury?*
No
Yes

If yes, please enter details below.

Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's physical history
Does the Participant have a preexisting injury?*
No
Yes

If yes, please enter details below.

Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's physical history
Does the Participant have a preexisting injury?*
No
Yes

If yes, please enter details below.

Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's physical history
Does the Participant have a preexisting injury?*
No
Yes

If yes, please enter details below.

Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's physical history
Does the Participant have a preexisting injury?*
No
Yes

If yes, please enter details below.

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*
Please enter your postcode.
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 physical history
Does the Participant have a preexisting injury?*
No
Yes

If yes, please enter details below.

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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