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Parental Consent

Acknowledgement of risk and conditions of use

ABC Statement 

'All climbing activities have a risk of serious injury or death. Participants must recognise that even if they follow all good practise, they may still be the risk of accident and injury. It is the responsibility of the participants to adhere to the conditions of use'. 

It is Important that you understand this document, and that this agreement is held and recorded. There is inherent Risk involved with climbing centres and associated activities. By signing this Form, you are stating that you understand these risks cannot be completely removed. If you do not understand any of the terminology or content, ask a member of staff to clarify.

General Safety

- Report to the climbing reception on each visit before you climb.

- You must exercise care, common sense, and self-preservation at all times.

- Report any problems with the walls, equipment, or other climbers' behaviour to a member of staff immediately. This is particularly important with broken or spinning holds.

- Be aware of the other climbers around you and how your actions will affect them.

- Do not distract people while they are climbing or belaying.

- Never stand directly underneath someone who is climbing.

- If you have children, you must keep them under control and supervise them directly at all times. Be close enough to affect or control the child’s behaviour at all times.

- Please make yourself aware of the location of the fire exits in the building and fire assembly points.

As a user of this climbing wall, you must be aware of and accept the following:

- As with all sporting activities, injuries are possible in climbing and might be sustained despite the safety systems in place.

- Volumes on the walls are designed to enhance the quality of climbing but you must be aware of and accept that when climbing above them there is an additional risk of falling onto them.

- Climbing beyond your capabilities on any wall is likely to result in a fall. Any fall may result in an injury despite the safety systems in place. You must make your own assessment of the risks whenever you climb.

- Participants must understand that climbing while pregnant can increase the risk posed to mother and unborn child.

- Participants must be aware and accept that climbing holds can spin or break

- You must do everything reasonable and practical to avoid endangering yourself or others.

- You have to be aware of and adhere to the safety rules of the centre at all times.

- You must stand back from the climbing walls unless you are belaying or spotting a climber.

- You take responsibility for adequately maintaining your equipment.

Auto Belays

- If you are unsure in any way on how to use an auto belay, or have never used one before, then ask a member of staff for assistance before using one.

- The coloured box (usually yellow or red) on the ground around the auto belays is a landing zone; be aware of descending climbers when standing within it.

- Good practice instructions are located next/near to the auto belay. To ensure your own safety, please follow these instructions.

- Helmets, jewellery, and other items that can cause strangulation are not permitted on the Auto-belay

The Auto belay system has a maximum and minimum designed weight Limit. Even if your are within the weight limit, your body shape may make participating more of a risk to you. In this case, the decision of participation will be at the instructor or coach discretion.

Auto Belay Weight limits

Minimum Weight Limit : 20kg

Maximum Weight Limit : 150KG


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.

Duty of care

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.

Unsupervised Climbing

Before you can use the top ropes or lead walls without supervision the centre expects you to be competent in the use of a climbing harness, a suitable knot to attach a rope to the harness and a belay device to secure a falling climber or lower a climber from the wall using a rope.

Before you can use the bouldering walls without supervision, you must be aware of safe usage of bouldering and know how to use the bouldering walls safely.

You are required to register to say that you know how to top rope, lead or boulder, that you are prepared to abide by the conditions of use of the centre and that you understand the risks involved in your participation. Anyone who is not competent to climb unsupervised must be supervised by a competent Adult.

Under 18s - All children in the centre must be supervised by an Over 18 Unsupervised member

If an under 18 is recognised to be “unsupervised” or does anything which may increase risk or cause injury to another person, the staff reserves the right to stop my child’s participation in the activity and I understand that no refunds will be given in such circumstances.

Parental Consent for Climbing Activities at YMCA Newark and Sherwood Climbing Centre for Clip ‘n’ Climb, Rope climbing walls and bouldering.

For any under 18's attending sessions you will need to fill in this form

-If you are supervising a novice please fill in the novice supervision form

If a parent is attending a session they will need to complete the supervised climber form

If the parent is a competent climber and wishes to climber they will need to complete the Unsupervised Climber Form

Please sign to say you have read and agree to this document

June 14, 2024




First Participant's Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Medical Matters
Do you have any medical or are you taking any medication, you feel we should know about? (include all details about, Asthma, epilepsy, Diabetes if applicable)*
No
Yes

Please include below any details of any medicines being taken, any allergies e.g penicillin, plasters etc or any special dietary or other treatments necessary. Leave blank if not relevant. For children add the name next to the medication
Declaration of Fitness *
I declare that to the best of my knowledge; I do not suffer from any medical conditions which might have the effect of making it more likely that I would be involved in an accident which could result in injury to myself or others

The Auto belay system has a maximum and minimum designed weight Limit. Even if your are within the weight limit, your body shape may make participating more of a risk to you. In this case, the decision of participation will be at the instructor or coach discretion.

Auto Belay Weight limits

Minimum Weight Limit : 20kg

Maximum Weight Limit : 150KG

Declaration of Fact *
I also confirm that the information provided is correct and if any information changes I will notify the centre
Declarations
I confirm I am age 18 or over and the parent or legal guardian of the above named minor(s) and that I consent to the minor(s) to take part in indoor climbing activities at the YMCA Newark and Sherwood Climbing Wall. *
Do you Understand there is a risk of injury involved for the participant*
Have you Read and understood this acknowledgement of risk, and conditions of use for climbing and bouldering? (if you have any questions please inform a member of staff)*
Do you understand failure to exercise due care could result in injury or Death*
Do you understand that the bouldering Matting does not remove the risk of death or injury?*
Do you Agree to abide by this document and the terms and conditions of the centre*
I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS DOCUMENT. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS*
Privacy and General Data Protection Regulations

The data collected on this consent form and acknowledgement of risk is stored for this purpose only and will not be used by the YMCA for marketing. This contact data is used to contact for an emergency, or if a parent is required for their child. 

To comply with GDPR we are required to notify you that it is necessary to collect and store your personal Data. YMCA Robin Hood Group is the data controller. We require your Data to ensure that you comply with the Terms and Conditions of use of the centre, and as proof of this Acknowledgment of risk

We will store your data correctly and will not disclose to any third party. At any time you can request a copy of your data free of charge. GDPR, makes provisions for you to have your data erased and removed. This is known as the 'right to erasure/ right to be forgotten'. When the data is held for the establishment, exercise or defence of legal claims we have the right to refuse to erase the data. For this reason, our insurers insist that we continue to hold your data for 3 years from the date of your most recent visit.

In the case of Under 18 year olds, this is extended to 3 years beyond their 18th birthday. If you make a written request for erasure of your data, this request will be logged and the data will be erased after the period above.


Legal 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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