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CLIMBING WALL WAIVER

WAIVER & RELEASE

• ALL climbers, including CLUB certified climbers, must check in at the desk prior to using the wall.

• Certified individuals may climb at any time the wall is not in use by The Club at Prairie StoneTM. CLUB programming is given priority when utilizing the wall, but certified individuals may be permitted to climb, if granted permission by CLUB staff responsible for the program.

• All climbers agree to use the double-check exchange before beginning each climb. The belayer will check the climber’s gear, the climber will check the belayer’s system and exchange confirmation that the equipment is okay. This must be performed at the start of each climb.

• Climbers must be oriented to the operation and use of the auto belay.

• To belay, individuals must be 14 years of age or older, be certified by the CLUB and agree to utilize proper belaying technique.

• Belayers must keep the climber in eye contact at all times.

• Only approved climbing equipment may be used in the climbing area.

• Any infractions of the above rules will result in loss of privileges. Repeated infractions may result in the loss of climbing privileges, certification and/or club membership.


CLIMBING WALL RULES & REGULATIONS

• All climbers must be 4-years of age or older and sign the Waiver & Release below prior to their first climb, and annually thereafter. Climbers under the age of 18 must have the Waiver & Release form signed by a parent or legal guardian.

• All climbers will comply with the judgments and instructions of the CLUB staff.

• Must show CLUB staff their proof of payment when entering the climbing area.

• Any climbers under 66 lbs must use the child full body harness. If under 45 lbs must have a tag line attached to their harness when using the auto belay.

• Only chalk balls may be used for climbing, loose or block chalk is not permitted.

• No hard-soled or lug shoes are permitted on climbing surfaces. Rock climbing or athletic shoes are recommended. No bare-foot climbing is permitted.

• No climbing or bouldering is permitted on the wall without the supervision of a certified member of CLUB staff, or an individual who is certified by The Club at Prairie StoneTM

• When bouldering, each climber must have at least one spotter, and the boulder’s feet can not exceed the height of the spotter’s shoulders.

• Upon completion of the certification course, individuals will be recorded as “certified” and added to the certified climbers list. Certified individuals must recertify annually to maintain their “certified” status.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
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
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:*

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.

I, the undersigned parent or legal guardian of (“Minor”), hereby execute the foregoing Waiver & Release. For and on behalf of Minor and agree to bind myself, Minor and any heirs, next of kin, assigns or personal representatives to the terms of this Waiver & Release. I represent that I have full legal authority to act for an on behalf of Minor, and I agree to indemnify and hold harmless The Club at Prairie StoneTM for any expenses, claims or liabilities that may arise as a result of any insufficiency of my full legal authority to execute the foregoing Waiver & Release.



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*
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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