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Perse Climbing Wall

Instructor Led Session

Acceptance of Risk Form

Participation statement

If you are unsure of any aspect of the form you should not fill this in online. Please come to the Perse Sports Centre and fill it in where a staff member can answer any questions or clarify any points that may be unclear. If you have any impairments that can affect your filling in of the form or climbing, please fill in the form within the centre with staff support.

“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.

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.

T&Cs and Conditions of Use

Please read our terms and conditions of use for the climbing wall here:

Terms and Conditions - The Perse Sports Centre

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.

Declarations

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 HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS.


I have read and understood the conditions of use and T&C's. I agree to abide by them. If relevant, I have explained the conditions of use to my child, they agree to abide by them.

I Agree

I understand there is a risk of injury involved


I have read and understood this Acknowledgment of Risk for climbing or bouldering activities? (If you have any questions inform a member of staff)


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? 


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

Group Members

Please add the names of the group members using the 'Minors' section below. Due to limitations with the waiver platform, you can only add up to ten members. If there are more in your group, please create a new waiver and add the remaining names.


First Your Name

First Name*

Last Name*

Phone*
First Your Date of Birth*
First Your Signature*
Second Your Name

First Name*

Last Name*
Second Your Date of Birth*
Third Your Name

First Name*

Last Name*
Third Your Date of Birth*
Fourth Your Name

First Name*

Last Name*
Fourth Your Date of Birth*
Fifth Your Name

First Name*

Last Name*
Fifth Your Date of Birth*
Sixth Your Name

First Name*

Last Name*
Sixth Your Date of Birth*
Seventh Your Name

First Name*

Last Name*
Seventh Your Date of Birth*
Eighth Your Name

First Name*

Last Name*
Eighth Your Date of Birth*
Ninth Your Name

First Name*

Last Name*
Ninth Your Date of Birth*
Tenth Your Name

First Name*

Last Name*
Tenth Your Date of Birth*
Parent or Guardian's Email Address

Email
Check to receive information about from the Perse School via e-mail.
A signed copy of this waiver will be sent to the email address you provide.
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*
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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