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Mandurah Indoor Rock Climbing
Release of Liability and Assumption of Risk

Please read this document carefully.

Climbing indoor or outdoor, Ninja training and Aerials are sports with obvious risks as defined by the Civil Liability Amendment (Personal Responsibility) Act. In signing this document, you are agreeing to participate in any activity at MiRC “At your own risk “This document serves as a record that you have read and understand this and have with full knowledge of the risks, accepted the risk and chosen to participate of your own accord.

Risk: I understand that all activities at Mandurah indoor Climbing Centre involve risks that may cause various injuries and that such injuries may be serious. I also understand that Indoor Top rope climbing, Leading, Bouldering, Ninja Training, Aerial Training and Outdoor climbing are physically demanding and in susceptible people may cause panic, hyperventilation and/or heart attack.

Safety Induction: I have been advised (or am aware I will be advised) of the risks and safe climbing and training methods. I will not climb or take part in any activity unless I have understood them clearly and asked questions and received answers that have clarified anything I was uncertain of. I am aware that if there is something I forget or become unsure about after my safety induction that I can ask a MIRC staff
member.

Future Acceptance: I am aware that this acceptance is ongoing and will apply to all future occasions where I participate in any activity at Mandurah Indoor Rock Climbing Centre. I furthermore acknowledge that this document is contractual and may be relied upon in proceedings by me, my heirs, executors and assigns.

Rules: I have been provided the MIRC rules and have read and agree to their terms. I understand that not following these rules can and will increase the risks to myself and others.

Participant’s health: The Participant warrants that he or she has no medical condition that will affect his or her ability to participate in any activity and if unclear will notify MIRC Staff prior to commencing.

Where Climber under 18: The Participant’s parent/guardian acknowledges and agrees that the sport of rock climbing, ninja and aerial training and the use of the facilities owned and maintained by MiRC has inherent risks of injury. The Participant’s parent/guardian realises that the Participant may suffer injury from any of these activities, and that the highest safety standards and equipment cannot remove all of the dangers to the Participant.

Publicity: I give permission for any promotional offers and information to be sent to my email provided and for any form of publicity, photographs or videos that has been taken in Mandurah Indoor Rock Climbing Centre to be used by the gym for publicity use only.

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. I, WITH FULL UNDERSTANDING OF THE RISKS, HAVE CHOSEN TO CONTINUE TO PARTICIPATE AND/OR ALLOW THE ABOVEMENTIONED MINORS TO PARTICIPATE IN ALL ACTIVITIES AT MANDURAH INDOOR ROCK CLIMBING CENTRE.

 


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*
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
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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