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Junior Supervision & Parental Consent form


This form can be completed in full if you are both the Parent/ Guardian and the Supervisor of the young person named below, or if both are present. If you are the Supervisor only or the Parent/Guardian only, please write n/a in the other section and have the other party complete a separate form.


Parental Consent

Parents and guardians must be aware of and accept that all climbing and bouldering activities have a risk of serious injury or death. Even if the supervisor is following best practice and children are compliant with centre rules, injuries can still occur.

Although your child will be under supervision, supervisors cannot prevent climbers from falling from the bouldering wall onto the matting. The matting under the walls does not guarantee the safety of a climber.

By signing below I confirm that I am the parent/ guardian of the above named junior and that I understand the above information.



Supervisor's agreement- To be completed by the adult who is supervising the young climber. 

You may supervise a maximum of two children at a time while in Gravity. If you are supervising children you must supervise them directly and ensure that they comply with the conditions of use at all times. 

You should encourage children under your supervision to climb within their ability and to avoid uncontrolled falls.

It is of utmost importance that children under your supervision do not go into the landing zone of another climber. Doing so could result in serious injury to them, or to the climber.

You must stay close enough to affect the child's behavior at all times. 

By signing below I confirm that I understand the requirements for supervision and Gravity's Conditions of Use and am responsible for supervising the above named junior. 



Please select who will be supervising
Minor
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First Supervising Adult Name

First Name*

Last Name*
First Supervising Adult Date of Birth*
First Supervising Adult Signature*
Please let us know here if the young climber suffers from any medical condition that might affect their participation.

(please let us know here if there is anything we should be aware of- e.g. allergies, medications)
Supervising Adult

First Name *

Family Name *

Date of Birth *
I agree to supervise the above named minor, in accordance with the Supervisor's Agreement above, on this date and for future visits (valid for 1 year)*
Parent/Guardian Email Address

Email*

Confirm Email*
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/Guardian Name

First Name*

Last Name*
Parent/Guardian Date of Birth*
Parent/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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