Acknowledgement of Risk Form  


Adult Climbing


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.”  


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. If you do not understand any of the terminology or content, ask a member of staff to clarify.  

Conditions of use  

General Safety 

- Report to reception on each visit before you climb.  

- You must exercise care, common sense and self-preservation at all times.  

- Use the storage boxes provided for bags and drinks. 

- Report any problems with the walls, equipment or other climbers' behaviour to a member of staff immediately. This is particularly important with broken or spinning holds.  

- Be aware of the other climbers around you and how your actions will affect them.  

- Do not distract people while they are climbing or belaying.  

- Never stand directly underneath someone who is climbing.  

- If you have children, you must keep them under control and supervise them directly at all times. Be close enough to affect or control the child’s behaviour at all times.  

- Please make yourself aware of the location of the fire exits in the building and fire assembly points.  

- Follow any instructions given to you by a member of staff or posted on the wall. 


As a user of this climbing wall, you must be aware of and accept the following:  

- Volumes on the walls are designed to enhance the quality of climbing but you must be aware of and accept that when climbing above them there is an additional risk of falling onto them.  

- Climbing beyond your capabilities on any wall is likely to result in a fall. Any fall may result in an injury despite the safety systems in place. You must make your own assessment of the risks whenever you climb.  

- Participants must understand that climbing while pregnant can increase the risk posed to mother and unborn child.  

- Participants must be aware and accept that climbing holds can spin or break  

- You must do everything reasonable and practical to avoid endangering yourself or others.  

- You have to be aware of and adhere to the safety rules of the centre at all times.  

- Stand back from the climbing walls unless you are belaying or spotting a climber.  

- You take responsibility for adequately maintaining your equipment.  

- Please empty your pockets and remove all jewellery before climbing.  


Top Rope Climbing 

- Always use a climbing harness to attach yourself to the rope tying the rope directly into the harness using a figure of 8 knot with a stopper, or a bowline knot with a stopper. Clipping in with a carabiner is not advised.  

- Many of the climbs in the centre have top ropes already in place. Do not take them down or move them.  

- Be vigilant when top roping next to a lead climber, give them enough space to fall into. 

- It is your responsibility to vet your climbing partner's ability before they belay you.  


Lead Climbing 

- Lead belaying requires a higher degree of skill and understanding from top rope belaying and should only be undertaken if you have received training or are competent to do so. If you are unsure do not climb and ask a staff member for available instruction at the centre.  

- When using the lead walls, you must supply or rent (if available) your own appropriately rated dynamic rope.  

- Quickdraws/runners/clips are provided on the lead wall. Please don’t use your own.  

- You must not skip clips and clips must be clipped in order.  


When Belaying 

- Always abide by good practice when belaying.  

- Always use a belay device attached to your climbing harness with a locking carabiner as per manufacturers' guidelines. ‘Traditional’, or ‘body’, belaying is not acceptable.  

- To ensure your partner's safety, pay attention to what the climber is doing.  

- Always stand as close to the climbing wall as is practical. Sitting or lying down is not acceptable.  



- Whenever possible downclimb, or if this is not possible, use a controlled/planned jump.  

- It is your responsibility to ensure that you can climb down or land safely; don’t climb into a situation that you cannot safely get out of.  

- Never climb directly above or below another climber.  

- Always take your harness off before bouldering.  

- Remove anything from pockets that could hurt you when landing.  

- Always be aware of people climbing above and around you, check in the mirror when passing through the arch. 


Training Area 

- You use the training equipment at your own risk. If you are unsure how to safely use any item, please ask a member of staff.  


Auto Belays 

- If you are unsure in any way on how to use an auto belay, or have never used one before, then ask a member of staff for assistance before using one.  

- The coloured box (usually yellow or red) on the ground around the auto belays is a landing zone; be aware of descending climbers when standing within it.  

- Good practice instructions are located next/near to the auto belay. To ensure your own safety, please follow these instructions.  



The bouldering wall is the site of most injuries at a climbing wall. THE SOFT MATTING DOES NOT REMOVE THE RISK OF INJURY. Injuries can still occur even after a controlled/planned jump but are more likely after an uncontrolled fall. You should always be doing your utmost to avoid the risk of uncontrolled falls. This includes paying attention to how you will land and always assessing the risk of each climb that you undertake.  

Lead climbing also contains inherent risks, which are always present. Any leader fall can result in an injury and you must exercise great caution and preparation before you expose yourself to that risk. In top roping and leading, the greatest risk is presented by the belayer. Always make sure they are skilled enough to keep you safe; if you are unsure consult a member of staff.  


Our Duty of Care – The conditions of use of the climbing centre are not intended to limit your enjoyment of the facilities; they are part of the duty of care that we, as operators, owe to you, the customer, by law. As such, they are not negotiable and if you are not prepared to abide by them then the staff may ask you to leave.  

Your Duty of Care – You have a duty of care to act responsibly towards the other users of the centre, follow good practice and abide by the conditions of use of the centre. Statements of ‘Good Practice’ are posted around the centre adjacent to the relevant facilities. These describe the accepted methods of use of equipment and climbing areas.  


Unsupervised Climbing  

Before you can use the top ropes or lead walls without supervision the centre expects you to be competent in the use of a climbing harness, a suitable knot to attach a rope to the harness and a belay device to secure a falling climber or lower a climber from the wall using a rope. Before you can use the bouldering walls without supervision, you must be aware of safe usage of bouldering and know how to use the bouldering walls safely. You are required to register to say that you know how to top rope, lead or boulder, that you are prepared to abide by the conditions of use of the centre and that you understand the risks involved in your participation. Anyone who is not competent to climb unsupervised must be supervised by a competent person.  


Supervised Climbing 

An adult who has registered at the centre and proved competency, may supervise up to two novice climbers, as long as they are prepared to take full responsibility for the safety of those people.  

Groups of three or more novices must only be supervised by an instructor holding a relevant valid Mountain Training qualification (or other relevant qualification) and insurance. All children in the centre must be supervised by an adult unless they have been assessed by the management and registered for unsupervised climbing.  



I certify that to the best of my knowledge, I do not suffer from a medical condition that might have the effect of making it more likely that I be involved in an accident that could result in injury to myself or others.  

I also confirm that the above information is correct and if any information changes I will notify the centre.  



First Participant's Name

First Name*

Last Name*

First Participant's Date of Birth*
First Participant's Information

Any relevant medical conditions
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Any relevant medical conditions
Third Participant's Name

First Name*

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

Any relevant medical conditions
Fourth Participant's Name

First Name*

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

Any relevant medical conditions
Fifth Participant's Name

First Name*

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

Any relevant medical conditions
Sixth Participant's Name

First Name*

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

Any relevant medical conditions
Seventh Participant's Name

First Name*

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

Any relevant medical conditions
Eighth Participant's Name

First Name*

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

Any relevant medical conditions
Ninth Participant's Name

First Name*

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

Any relevant medical conditions
Tenth Participant's Name

First Name*

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

Any relevant medical conditions
Emergency Contact Email Address


Confirm Email*
Check to receive information, news, and discounts by e-mail.
Are you over 18 years of age?*
Do you wish to receive any paid training or instruction before proceeding to use the bouldering / wall facilities, including such equipment as has been hired to you for your use? (If yes, please ensure you have informed a member of staff)*
Do you understand there is a risk of injury involved? *
Have you read and understood this Acknowledgment of Risk and Conditions of Use for climbing or bouldering? (If you have any questions inform a member of staff) * *
If you intend to lead or top rope, can you fit a climbing harness correctly, attach a rope to your harness using a suitable climbing knot and use a belay device to secure a falling climber and lower a climber from the wall? If under instruction or bouldering, please answer no.*
Do you require any instruction in any of the above techniques required for top rope or lead climbing?*
Do you understand that failure to exercise due care could result in your injury or death?*
Do you understand that the boulder matting does not remove the risk of injury?*
Have you watched and understood the bouldering safety video and understand good practice for use of the bouldering?*
Do you agree to abide by this document and the conditions of use of the climbing centre?*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.

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.
Emergency Contact Name

First Name*

Last Name*

Emergency Contact Date of Birth*
Emergency Contact Information

Any relevant medical conditions
Emergency Contact 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