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Hadley Family Recreation & Well-Being Center

Climbing Center Participation Assumption of Risk Form


By participating in Climbing Center activities, including bouldering (unroped climbing), top rope climbing, lead climbing, speed climbing, rappelling, crack climbing, auto-belay climbing, belaying, instruction, competitions, events, and related programming, I understand that there is a degree of risk to my health and safety. That risk is dependent in part on my level of fitness, medical condition, climbing ability, judgment, and activity choice. By participating, I declare that I am physically able to engage in climbing activities and assume the risk and responsibility for my participation. I agree to alert staff to any personal difficulty, emotional distress, sickness, fatigue, injury, or other problem that may change or limit my participation.

Possible injuries and complications include, but are not limited to:

Sprains or strains; broken bones; dislocations; head injuries; concussions; scrapes or cuts; rope burns; abrasions; internal injuries; overuse injuries; dehydration; exposure to communicable diseases; paralysis; and death.

These injuries and complications may result from, among other things:

Falls from height while top rope, lead, or speed climbing; ground falls during bouldering; landing on, between, or off padded surfaces; impact with climbing holds, volumes, wall features, ropes, quickdraws, or other participants; falling objects such as holds, hardware, or equipment; malfunction, improper use, or failure of ropes, harnesses, carabiners, belay devices, auto-belay systems, anchors, or other safety equipment; improper belaying; weight differences between climber and belayer; repetitive stress; route setting, inspection, or maintenance activities; airborne chalk; slippery flooring; my own decision making and failure to acknowledge my personal skill and ability levels; and the actions or inactions of other participants.


MEDICAL AUTHORIZATION

I authorize the University of Michigan, its staff, employees, clinicians, trainers, nurses, and agents to seek, obtain, and approve any emergency medical care and treatment that may be necessary for my health and well-being during or related to my participation.. I represent that I have health insurance and agree that I am solely responsible for any costs incurred.


PARTICIPANT RESPONSIBILITIES

I agree to abide by Climbing Center policies and all applicable University rules and regulations, including but not limited to:

• Completion of required orientations and successful skills assessments prior to belaying or leading.

• Proper inspection and use of all harnesses, ropes, carabiners, belay devices, anchors, and auto-belays.

• Proper fall technique and awareness of landing zones while bouldering.

• No participation while under the influence of drugs or alcohol.

• Respect for staff direction and other participants.

• Observance of temporary closures during route setting, inspection, or maintenance.

• Compliance with public-health requirements or protocols.

If I need to leave due to injury, illness, emotional distress, or violation of policies, I understand that I am responsible for any resulting costs.


RELEASE AND INDEMNIFICATION

To the fullest extent permitted by law, I agree to release The Regents of the University of Michigan, including the Climbing Center, its agents, employees, volunteers, and contractors, from any and all damages, liability, claims, expenses, or loss resulting from or arising out of my participation in Climbing Center activities. I further agree to indemnify and hold harmless the University, its agents and employees, from any claims resulting from my negligence, impermissible conduct, or violation of policies in connection with Climbing Center activities.


DECLARATION

I declare that I am 18 years of age or older and that I have read, understood, and agree to the contents of this Participation Consent and Release Form in its entirety. I understand that climbing involves inherent risks, including the risk of serious injury or death. Any questions I have regarding this agreement have been discussed with Climbing Center staff.




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First Participant's Name
First Name*
Last Name*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Parent or Guardian's Email Address
Email*
Confirm Email*
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Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Emergency Contact's Relation to Participant
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*
Relationship*
Phone*
Parent or Guardian's Date of Birth*
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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