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You are advised that bouldering is a Dangerous Recreational Activity with Obvious Risks as defined by the Civil Liability Amendment (Personal Responsibility) Act. YOU ARE PARTICIPATING AT YOUR OWN RISK.

TO ensure that you understand this, please read, and agree to the following:

I understand and acknowledge the Civil Liability Act 2002 (NSW)

I understand that indoor bouldering involves risks that may cause various injuries which may result in injuries, serious disability or death. I also understand that indoor bouldering is physically demanding and at high risk people may cause panic, hyperventilation, or heart attack.

I Agree

I am aware of the risks that have been stated about indoor bouldering and wish to participate and do so entirely at my own risk of injury or bodily harm to myself.

I Agree

I hereby release Climber Collective, all affiliates and any other persons involved in my participation of any suit, demand, action or claim for compensation whether for personal injury or damage to property arising from my participation.

I Agree

I will listen to all instructions given to me by Climber Collective employees and comply to all signage provided on the premises.

I Agree

I will not participate in maneuvers that are not set out on a route by Climber Collective eg. dyno, bat hang and other gymnastic style movements 

I Agree

I do not suffer from any medical condition that may affect my ability to participate safely in the activities.

I Agree

I am aware that this waiver is ongoing and will apply to all future occasions I participate in indoor bouldering at Climber Collective. I furthermore acknowledge that this document is contractual and may be relied upon in any proceedings by me, my heirs, executors, and assigns.

I Agree

I am aware that, if I supply my email details, I may receive e-newsletters relating to sales, events and updates

I Agree

I am aware that Climber Collective have CCTV and audio recording that will be in use and used to survey the premises for the safety of clientele and staff.

I Agree

I give Climber Collective employees, staff and assistants consent to use my name/Photograph/image/audio recording/video recording and likeness in all forms and manner for the purposes of advertising, media publicity and or general display.

I Agree

I am aged 18 years or over and am legally competent to sign this agreement.

OR

My parent or legal guardian has signed this form to consent to my participation.

I Agree

 

Date: April 12, 2024
 

Unit 4 /55-61 York Road Jamisontown 2750 Tel: 02 47077278
ABN: 76154139500
e-mail hello@climbercollective.com.au www.climbercollective.com.au

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First 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*
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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