Loading...

CENTRAL MICHIGAN UNIVERSITY
INFORMED CONSENT AND RELEASE
CLIMBING, RAPPELLING AND HIGH ROPES COURSES 

I have been informed and fully realize there are dangers and risks to which I may be exposed while participating in this planned activity. These risks may include the possibility of slight or severe bodily injury, or death, from hazards including but not limited to:

1. Injuries resulting from falling or crashing into walls.

2. Injuries resulting from rope abrasions, entanglement and other injuries that may result from activities or other persons, including climbing, belaying, rappelling and high ropes elements.

3. Injuries such as abrasions or cuts resulting from contact with the climbing wall, holds, ropes course or equipment.

4. Injuries resulting from falling climbers, equipment, climbing hardware, etc.

5. Injuries resulting from any equipment failures, including, but not limited to, failures of ropes, harnesses, anchor points, or any part of the climbing structure.

6. Injuries resulting from not following proper and customary personal safety procedures and the Safety Policies and Procedures of CMU which form a part of this agreement.

7. Injuries resulting from the negligence of other climbers, participants, spectators or users of the facility, including belayers or spotters.

8. Injuries resulting from personal physical and mental limits, including fatigue, dizziness, mental stresses, which may diminish reaction time and increase risk of accident, personal strength, coordination, sense of balance, and ability to follow or give directions while climbing, belaying, or repelling. 

I understand that Central Michigan University does not require me to participate in this activity, but I want to do so, despite the possible risks and this Release.

I therefore freely and voluntarily agree to assume and take on myself all of the risks and responsibilities in any way associated with this activity. I release Central Michigan University, its Board of Trustees, employees, and agents from all liability, claims, and actions that may arise from injury or harm to me, from my death, or from damage to my property in connection with this activity. I understand that this Release covers liability, claims, and actions caused entirely or in part by any acts or failures to act of Central Michigan University, or any of its employees or agents, including but not limited to negligence, mistake, or failure to supervise. I understand that this Release does not apply to instances of intentional misconduct by a University employee or agent.

I know that if I become ill or injured while participating in this activity, I am responsible for my health care expenses and I have made arrangements to handle such expenses through insurance coverage, access to cash, or other methods.

I assume full responsibility for any and all claims and costs arising directly or indirectly from any of my activities, acts, or omissions while participating in this activity.

I further release Central Michigan University, its Board of Trustees, employees or agents from liability for any claim of loss, injury, or damage to me or my property due to any act, omission, or negligence of parties not an agent or employee of Central Michigan University, including, but not limited to, owners or contractors providing equipment or other services.

These releases are effective for me, my personal representative, assigns, and heirs.

I HAVE CAREFULLY READ AND UNDERSTAND COMPLETELY THE ABOVE PROVISIONS, AND VOLUNTARILY SIGN THIS RELEASE. 

Date: January 25, 2026

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
Information
Age:
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Age:
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Age:
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Age:
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Age:
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Age:
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Age:
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Age:
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Age:
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Age:
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Participant's 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:*
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
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*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Information
Age:
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE! and  Rock Gym Pro