Protection of Privacy - The personal information requested on this form is collected under the authority of Section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act and will be protected under Part 2 of that Act. It will be used for the purpose of administering the Wilson Climbing Wall Activities and Programs, managing records retention, and/or to communicate with the emergency contact in case the participant is seriously injured or ill. Direct any questions about this collection to: Wilson Climbing Centre, Campus & Community Recreation, Van Vliet Centre, University of Alberta, 780- 492-2767, climbing@ualberta.ca

Loading...
INFORMED CONSENT
PARENT/GUARDIAN: PLEASE READ CAREFULLY
BY SIGNING THIS FORM, YOU ACCEPT CERTAIN LEGAL OBLIGATIONS

Review University of Alberta Privacy Policy

Assumption of Risks

I, the undersigned, understand and acknowledge in consideration of my child using the facilities that include the climbing walls, equipment and/or participating in any activities related to the climbing wall (collectively, the “Climbing Activities”), that I will instruct my child to obey at all times, the climbing wall rules and regulations as well as read and agree to this informed consent. I am further aware that the Climbing Activities have inherent dangers and I freely accept all risks, dangers and hazards associated with the Climbing Activities including the possible risk of severe or fatal injury to my child or others. These risks include, but are not limited to:

  1. Injuries resulting from the impact with other climbers or dropped items such as ropes or climbing hardware;
  2. The risks associated with the design, manufacturing or installation of the facility infrastructure and its related equipment;
  3. The risks and negligence, inattention or inexperience of others in the facility including use of the climbing wall including belayers;
  4. Head, facial, dental and neurological injuries such as concussions and traumatic brain injuries (TBI);
  5. Falling against, impacting, entanglement or impairment on apparatus, equipment or other natural or man-made obstacles (visible or not visible), or against the ground, floors, walls or other surfaces;
  6. Contact with participants, officials, spectators or other people or sustaining injuries arising from their actions;
  7. My child’s participation and/or use of equipment beyond their own skills and abilities;
  8. Rope abrasions, entanglement and other injuries resulting from activities such as rescue systems, climbing, belaying, rappelling, smearing, edging. Hand holds or other movement skills and any other rope techniques;
  9. Falls, slips, trips, sprains, abrasions, impacts or other such accidents that can arise from an uneven and/or soft surfaces;
  10. Injuries resulting from use, misuse, non-use or failure of any equipment including, but not limited to, ropes, slings, harnesses, climbing hardware, anchor points or any part of the climbing structure;
  11. Injuries or illness resulting from failure to follow directions, instructions and guidelines provide by those in charge of the activity;
  12. Increased injury and/or illness that arises from use of the facility including climbing wall and related equipment as a result of aggravation to a pre-existing medical conditions;
  13. Injury resulting from impact with obstructions, equipment, other participants or spectators;
  14. Potential exposure to infectious and communicable disease, including but not limited to COVID-19.


Release of Liability and Indemnification

In consideration for the University allowing my child to participate in the Climbing Activities, I agree:

  1. that the Governors of the University of Alberta, their officers, employees, and volunteers (hereinafter referred to as the “University”) are not responsible for any loss, damage, injury or expense of any kinds sustained by my child while participating in the Climbing Activities and all related activities in the facility;
  2. to WAIVE ANY AND ALL CLAIMS that I have or may in the future have against the University arising out of any aspect of my child’s participation in the Climbing Activities and to RELEASE the University from any and all liability resulting from any loss, damage, injury (including death) or expense that my child may suffer as a result of my child’s participation in the Climbing Activities, due to any cause whatsoever, including without limitation, negligence, breach of contract, or breach of any statutory or other duty of care, as well as any duty of care owed under the Occupiers’ Liability Act (Alberta) on the part of the University;
  3. to INDEMNIFY AND HOLD HARMLESS the University in relation to:

a. any damage to University property caused by my child;

b. any and all liability for any damages to the personal property of, or personal injury to, any third party resulting from my child’s participation in the Climbing Activities; and

c. any and all claims, demands, actions and costs which might arise out of my child participating in the Climbing Activities.



Acknowledgement

I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THIS AGREEMENT before signing it, that I have executed this Agreement voluntarily, and that this Agreement is to be binding upon myself, my heirs, executors, administrators and representatives. Further, I acknowledge and agree:

  1. To instruct my child to follow all rules and guidelines set out by the University and its representatives related to the Climbing Activities and all related activities in the facility.
  2. That I will instruct my child to climb safely and within his or her abilities.
  3. That I will instruct my child to wear appropriate attire, including footwear, for all climbing activities.
  4. That if any portion of this Agreement is determined to be invalid, that the remainder of this Agreement remains in full force and effect.



Signed this day of: April 4, 2026

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant's Information
Identification Number: (UAlberta ID, if applicable)
Climbing Type: *
Drop In
Program
Belay Test
Booking
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Identification Number: (UAlberta ID, if applicable)
Climbing Type: *
Drop In
Program
Belay Test
Booking
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Identification Number: (UAlberta ID, if applicable)
Climbing Type: *
Drop In
Program
Belay Test
Booking
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Identification Number: (UAlberta ID, if applicable)
Climbing Type: *
Drop In
Program
Belay Test
Booking
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Identification Number: (UAlberta ID, if applicable)
Climbing Type: *
Drop In
Program
Belay Test
Booking
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Identification Number: (UAlberta ID, if applicable)
Climbing Type: *
Drop In
Program
Belay Test
Booking
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Identification Number: (UAlberta ID, if applicable)
Climbing Type: *
Drop In
Program
Belay Test
Booking
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Identification Number: (UAlberta ID, if applicable)
Climbing Type: *
Drop In
Program
Belay Test
Booking
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Identification Number: (UAlberta ID, if applicable)
Climbing Type: *
Drop In
Program
Belay Test
Booking
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Identification Number: (UAlberta ID, if applicable)
Climbing Type: *
Drop In
Program
Belay Test
Booking
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
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*
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*
Middle Name
Last Name*
Relationship*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Information
Identification Number: (UAlberta ID, if applicable)
Climbing Type: *
Drop In
Program
Belay Test
Booking
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!