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Climb Central Manila Facility Registration Form/Release of Liability and Assumption of Risk

Acknowledgement, Waiver & Release from Liability Agreement

I agree that this document is a legally binding agreement. By signing this agreement, I am acknowledging that I have read, understood and accepted the terms and conditions stated in this agreement. I further acknowledge and agree that I am waiving my rights to bring a court action to recover compensation or obtain any other remedy for any injury to myself or my property


Acknowledgement: I acknowledge that there are significant elements of risk associated with the sport of rock climbing, bouldering, fitness training regimes, and other similar activities provided by Climb Central by Power-Up Phil., Inc.. I further acknowledge the nature and extent of the risks inherent in climbing and the use of the facilities, including but not limited to injuries and death resulting from falling and crashing into the walls or other obstacles, falling climbers or dropped items, rope abrasions, entanglement, equipment failures, and injuries and death resulting from not following proper and customary safety procedures or from the negligence of other climbers, participants, spectators and users of the facilities. I acknowledge that the risks listed here are not inclusive of all possible risks associated with the use of the facility and that there are other unknown and unanticipated risks that may result in injury, illness or death.


Release, Assumption of Risk and Responsibility: In consideration of, and in recognition of the inherent risks associated with the activity and the use of the facility, I, and/or on behalf of any minor children which I am responsible for, agree, on behalf of myself, my/our heirs, representatives, successors, executors, administrators and assigns, to hereby release, waive, discharge and agree not to sue its officers, directors, shareholders, agents and employees, for any and all claims or demands, obligations and/or causes of action of any nature whatsoever which I may have against its officers, directors, shareholders, agents and employees, on account of any personal injury, property damage, death or accident of any kind, arising out of or in any way connected with use of the facility or equipment, whether my/our use is supervised or unsupervised and I/we agree to indemnify and hold harmless the persons or entities mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of my/our actions.


I further certify, acknowledge and agree on behalf of myself and/or any minor children for which I am responsible, that I am/we are physically and mentally capable of participating in the activity and/or use the equipment. I/we assume responsibility for and voluntarily assume the risks for any personal injury, death and related expenses involved with this activity. I/we assume responsibility for damage to my/our personal property, and I/we assume the risks for accidents or injury caused by the negligence of my fellow climbers.


I declare that all information given in this form is true and correct to the best of my knowledge and belief.


IN WITNESS WHEREOF, I have signed this agreement on this day.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's City of Residence

City of Residence *
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's City of Residence

City of Residence *
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's City of Residence

City of Residence *
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's City of Residence

City of Residence *
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's City of Residence

City of Residence *
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's City of Residence

City of Residence *
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's City of Residence

City of Residence *
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's City of Residence

City of Residence *
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's City of Residence

City of Residence *
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's City of Residence

City of Residence *
Parent or Guardian's Email Address

Email*

Confirm Email*
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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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's City of Residence

City of Residence *
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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