Loading...

WAIVER AND RELEASE OF LIABILITY

Climbing Café

5070 S 7th St, Terre Haute, IN 47802

Ph:

www.climbingcafe.com

 

RELEASE:  In consideration of being permitted to use the facilities of Climbing Café, at this location (5070 S 7th St, Terre Haute, IN 47802) or any other facility owned by or affiliated with Climbing Café or Hoosier Heights Indoor Climbing Facility, LLC (the “Facilities”), and mindful of the significant risks involved with the activities incidental thereto, I, for myself, my heirs, my estate and personal representatives, do hereby release and discharge Hoosier Heights Indoor Climbing Facility, LLC, d/b/a Climbing Café, its employees, members, directors, officers, agents, representatives, insurers and/or assigns (hereinafter collectively referred to as “Climbing Café”), from any and all liability for injury that may result from my use of the Facilities, and I do hereby waive and relinquish any and all actions or causes of action for personal injury, property damage, or wrongful death arising as a result of use of the Facilities and equipment, or any activities incidental thereto, wherever or however such personal injury, property damage, or wrongful death may occur, whether foreseen or unforeseen, and whenever such personal injury, property damage, or wrongful death may occur, from the date of this Release forward.  I agree that under no circumstances will I, my heirs, my estate, or my personal representatives present any claim for personal injury, property damage, or wrongful death against Climbing Café, whether said personal injury, property damage, or wrongful death arises by the negligence of Climbing Café, or otherwise.

It is the intention of the undersigned individual to exempt and relieve Climbing Café from liability for any personal injury, property damage, or wrongful death caused by negligence, including the negligence of Climbing Café.  It is the intention of the undersigned that this Release be in effect for use of the Facilities on the date of this Release and for use of the Facilities in the future.  This Release shall be legally binding upon me, my heirs, my estate, my personal representatives, as well as upon any and all other persons authorized to act for me or on my behalf or on behalf of my heirs, my estate, or my personal representatives. I also agree to indemnify and hold harmless Climbing Café from all liabilities incident to my involvement or participation in activities at the Facilities.

 

ASSUMPTION OF RISK:  I, the undersigned, acknowledge that I understand that there are significant elements of risk inherent in the sport of rock climbing, including those activities that take place indoors, and that these risks cannot be completely eliminated.  Accordingly, I recognize that the sport of rock climbing, including indoor rock climbing, is inherently dangerous and cannot be made safe.  In addition, I realize these risks also pertain to related activities such as bouldering, incidental weight training, team building, fitness training regimens, and equipment purchased or rented at the Facilities.  I realize those risks may include, but are not limited to, injuries resulting from falls, equipment failure, entanglement, falling or dropped items, or the negligence of other climbers, participants, belayers, spotters, Climbing Café, its employees, or other users of the Facilities.  I acknowledge that I understand that the above list is not inclusive of all possible risks associated with rock climbing or use of the Facilities and that other unknown and unanticipated risks may result in injury, illness, paralysis, or death.

I, the undersigned, acknowledge that I have carefully read the above release of liability and fully understand its contents and that I fully agree with its terms and conditions.  I understand that by signing this release of liability I am knowingly and willingly agreeing to release Hoosier Heights Indoor Climbing Facility, L.L.C. d/b/a Climbing Café and its employees, members, directors, officers, agents, representatives, insurers and/or assigns of their liability for any personal injury, property damage, or wrongful death EVEN IF CAUSED BY THE NEGLIGENCE OF HOOSIER HEIGHTS INDOOR CLIMBING FACILITY, L.L.C. D/B/A CLIMBING CAFÉ, IT'S EMPLOYEES, MEMBERS, DIRECTORS, OFFICERS, AGENTS, REPRESENTATIVES, INSURERS AND/OR ASSIGNS, or otherwise.

 

FACILITY RULES

(Subject to change without notice)

I AGREE TO THE FOLLOWING FACILITY RULES:

All Participants must check in at front desk upon arrival for each visit and have a signed Waiver and Release of Liability on file.

Participants under 18 years of age must have this Waiver and Release of Liability signed by a parent or legal guardian.

All Participants must receive a facility orientation and be approved by Climbing Café staff prior to participating.

All Participants must use equipment approved by Climbing Café. All Participants must use such equipment in a manner approved by Climbing Café.

Climbing Café is not responsible for lost, stolen, or damaged items.

Climbing Café is a drug, alcohol, and tobacco free environment.

Foul language, horseplay, tumbling on landing surfaces, running, unruly conduct, and other such behaviors are not allowed.

Food and drinks are allowed only in designated areas.

Management has the right to suspend or terminate any Participant's membership or pass for violation of any facility rules, or for any other conduct deemed by staff to be inappropriate, disruptive, or dangerous. No refunds will be given for such suspension or termination.

 

MEDICAL/PROMOTIONAL AUTHORIZATION

MEDICAL AUTHORIZATION:  I agree, on behalf of myself and on behalf of any minor child for whom I am responsible, to authorize any medical treatment deemed necessary in the event of any injury or illness while participating in the use of the Facilities and/or equipment of the Facilities.  I agree, on behalf of myself and on behalf of any minor child for whom I am responsible to pay all costs of any rescue and/or medical services as may be incurred on my/our behalf.

PROMOTIONAL AUTHORIZATION:  I agree, on behalf of myself and on behalf of any minor child for whom I am responsible, that any film, photograph, or other recording of me/us, as users of the Facilities, become the property of Climbing Café, and may be used for promotional or commercial purposes.  Furthermore, I authorize Climbing Café to contact me and/or any minor child for whom I am responsible via telephone, e-mail, or standard mail with promotions and special events or programs.

 

Today's Date: April 4, 2025

 

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*
Addition Information
How did you find out about our facility?*

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. This is to certify that I, as a parent/guardian with legal responsibility for the above-listed participant, do consent and agree to the Release as provided above, of Climbing Cafe, and for myself, my heirs, assigns and next of kin, I release and agree to indemnify and hold harmless Climbing Cafe from all liabilities incident to my minor child’s involvement or participation in activities at the Facilities, as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF CLIMBING CAFE, to the fullest extent of the law.




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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE! and  Rock Gym Pro