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Consent Form for Children (u18) participating in a Stronghold Instructed Session


A Parent or Legal Guardian must complete the below Consent Form before the named child can take part in an instructed session at a Stronghold Climbing Centre.

Participation Statement

“All climbing and bouldering activities have a risk of serious injury or death. Participants must be aware of and accept that even if they follow all good practice there may still be the risk of accident and injury. It is the responsibility of the participant to adhere to the conditions of use.”

Before participating in climbing or bouldering at the Stronghold Climbing Centre the participating child and adult giving consent must have watched the Induction Video

It is important that you understand this document. There is inherent risk involved with climbing centres and associated activities. By signing this form you are stating you understand that these risks cannot be completely removed and are accepting the risks on behalf of the participant. If you do not understand any of the terminology or content, ask a member of staff to clarify.

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1) Declaration of fitness: I certify that to the best of my knowledge that the under 18 participant named below does not suffer from any medical conditions which might be adversely affected by participation in climbing activities at Stronghold

I Agree

2) I agree that the named child must not be left unattended at Stronghold until they are signed in under the supervision of an instructor, and that I will let Stronghold know in advance if someone other than the childs parents will be collecting them.

I Agree

3) I understand that in the interests of safety, the named child must follow the instructions of the staff at all times. Failure to do so may result in them not being allowed to continue with the activity.

I Agree

4) I, the adult giving consent, and the participating U18 year old have both watched the Stronghold Safety Induction video. 

I Agree

5) I have read and understand the Stronghold Terms and Conditions of use and rules

I Agree

6) I, the parent or legal guardian of this child, give permission for them to climb on an instructed session at Stronghold?

I Agree

I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS. 

Parent(s) or Court-Appointed Legal Guardian(s) must sign below and agree that they and the minor are subject to all the terms of this document, as set forth above.

Today's Date: January 28, 2023





Parent or Legal Guardian 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*
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:*
First Parent or Legal Guardian Name

First Name*

Last Name*

Phone*
First Parent or Legal Guardian Date of Birth*
I certify that I am 18 years of age or older
First Parent or Legal Guardian Information

If there is any additional information about the children being instructed, which you think it would be beneficial for the instructors to know, please add to the box below. This could be related to medical, allergies or dietary. 


Additional Information here please
First Parent or Legal Guardian Signature*
Second Parent or Legal Guardian Name

First Name*

Last Name*
Second Parent or Legal Guardian Date of Birth*
Second Parent or Legal Guardian Information

If there is any additional information about the children being instructed, which you think it would be beneficial for the instructors to know, please add to the box below. This could be related to medical, allergies or dietary. 


Additional Information here please
Third Parent or Legal Guardian Name

First Name*

Last Name*
Third Parent or Legal Guardian Date of Birth*
Third Parent or Legal Guardian Information

If there is any additional information about the children being instructed, which you think it would be beneficial for the instructors to know, please add to the box below. This could be related to medical, allergies or dietary. 


Additional Information here please
Fourth Parent or Legal Guardian Name

First Name*

Last Name*
Fourth Parent or Legal Guardian Date of Birth*
Fourth Parent or Legal Guardian Information

If there is any additional information about the children being instructed, which you think it would be beneficial for the instructors to know, please add to the box below. This could be related to medical, allergies or dietary. 


Additional Information here please
Fifth Parent or Legal Guardian Name

First Name*

Last Name*
Fifth Parent or Legal Guardian Date of Birth*
Fifth Parent or Legal Guardian Information

If there is any additional information about the children being instructed, which you think it would be beneficial for the instructors to know, please add to the box below. This could be related to medical, allergies or dietary. 


Additional Information here please
Sixth Parent or Legal Guardian Name

First Name*

Last Name*
Sixth Parent or Legal Guardian Date of Birth*
Sixth Parent or Legal Guardian Information

If there is any additional information about the children being instructed, which you think it would be beneficial for the instructors to know, please add to the box below. This could be related to medical, allergies or dietary. 


Additional Information here please
Seventh Parent or Legal Guardian Name

First Name*

Last Name*
Seventh Parent or Legal Guardian Date of Birth*
Seventh Parent or Legal Guardian Information

If there is any additional information about the children being instructed, which you think it would be beneficial for the instructors to know, please add to the box below. This could be related to medical, allergies or dietary. 


Additional Information here please
Eighth Parent or Legal Guardian Name

First Name*

Last Name*
Eighth Parent or Legal Guardian Date of Birth*
Eighth Parent or Legal Guardian Information

If there is any additional information about the children being instructed, which you think it would be beneficial for the instructors to know, please add to the box below. This could be related to medical, allergies or dietary. 


Additional Information here please
Ninth Parent or Legal Guardian Name

First Name*

Last Name*
Ninth Parent or Legal Guardian Date of Birth*
Ninth Parent or Legal Guardian Information

If there is any additional information about the children being instructed, which you think it would be beneficial for the instructors to know, please add to the box below. This could be related to medical, allergies or dietary. 


Additional Information here please
Tenth Parent or Legal Guardian Name

First Name*

Last Name*
Tenth Parent or Legal Guardian Date of Birth*
Tenth Parent or Legal Guardian Information

If there is any additional information about the children being instructed, which you think it would be beneficial for the instructors to know, please add to the box below. This could be related to medical, allergies or dietary. 


Additional Information here please
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 Legal Guardian Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Legal Guardian Date of Birth*
I certify that I am 18 years of age or older
Parent or Legal Guardian Information

If there is any additional information about the children being instructed, which you think it would be beneficial for the instructors to know, please add to the box below. This could be related to medical, allergies or dietary. 


Additional Information here please
Parent or Legal Guardian 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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