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RocVentures Climbing Gym

Health & Safety Agreement

This form is required annually for each RocVentures camper. It includes information on health conditions, immunization records, treatment consent, field trip consent, and sunscreen consent.

Please select who will be participating...
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First Participants Name

First Name*

Middle Name

Last Name*
First Participants Date of Birth*
First Participants Information

Health Conditions

Please check all the following that apply to the participant and that you would like to disclose. If you have no health conditions to disclose, please select "None" at the bottom of the list. *
Allergies
Asthma
Diabetes
Recent Surgeries
Serious Injuries
Seizures
Triggers
Hearing & Visual Conditions
Mental or Developmental Conditions
Medications
Chronic Conditions
Physical Limitations
Other Conditions, Implants or Devices
None Of The Above

For any items checked above, please include pertinent details here.

Immunizations

The Department of Health encourages camps to collect immunization records, however RocVentures does not require them. If you would like to share these records, you may drop a copy off or email them to the gym. *
Yes, I understand.

Medications

RocVentures prefers that prescription medications be administered at home whenever possible. If RocVentures needs to be responsible for campers' medications, the Department of Health requires that the medications must be in their original containers and clearly labeled with the camper's first and last name. Medications will not be checked in if they do not meet these requirements. Additionally, RocVentures is not permitted to assist campers in taking medications. *
Yes, I understand.

Medical Treatment

I hereby authorize RocVentures to obtain necessary emergency medical treatment for this participant, with the understanding that the parent, legal guardian, or emergency contact will be notified as soon as possible. I understand that I am responsible for any associated medical expenses. *
Yes, I understand.

Field Trips

I acknowledge that RocVentures may take participants on field trips off the property during the summer. I understand that these trips are weather-dependent and supervised. *
Yes, I understand.

Sun Screen

I acknowledge that regulations permit participants to carry and use FDA-approved sunscreen to protect against overexposure to the sun. RocVentures will encourage sunscreen usage when applicable but is not responsible for ensuring its use. *
Yes, I understand.

The form above is complete and accurate to the best of my knowledge. The specified participant has permission to engage in all activities unless otherwise noted. I have provided RocVentures with all relevant information that may assist in caring for this participant. I agree to promptly notify RocVentures staff in writing of any changes. I understand that failure to provide this information may jeopardize this participants health and safety. For any concerns or questions, I will contact RocVentures management.

First Participants Signature*
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.
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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Health Conditions

Please check all the following that apply to the participant and that you would like to disclose. If you have no health conditions to disclose, please select "None" at the bottom of the list. *
Allergies
Asthma
Diabetes
Recent Surgeries
Serious Injuries
Seizures
Triggers
Hearing & Visual Conditions
Mental or Developmental Conditions
Medications
Chronic Conditions
Physical Limitations
Other Conditions, Implants or Devices
None Of The Above

For any items checked above, please include pertinent details here.

Immunizations

The Department of Health encourages camps to collect immunization records, however RocVentures does not require them. If you would like to share these records, you may drop a copy off or email them to the gym. *
Yes, I understand.

Medications

RocVentures prefers that prescription medications be administered at home whenever possible. If RocVentures needs to be responsible for campers' medications, the Department of Health requires that the medications must be in their original containers and clearly labeled with the camper's first and last name. Medications will not be checked in if they do not meet these requirements. Additionally, RocVentures is not permitted to assist campers in taking medications. *
Yes, I understand.

Medical Treatment

I hereby authorize RocVentures to obtain necessary emergency medical treatment for this participant, with the understanding that the parent, legal guardian, or emergency contact will be notified as soon as possible. I understand that I am responsible for any associated medical expenses. *
Yes, I understand.

Field Trips

I acknowledge that RocVentures may take participants on field trips off the property during the summer. I understand that these trips are weather-dependent and supervised. *
Yes, I understand.

Sun Screen

I acknowledge that regulations permit participants to carry and use FDA-approved sunscreen to protect against overexposure to the sun. RocVentures will encourage sunscreen usage when applicable but is not responsible for ensuring its use. *
Yes, I understand.

The form above is complete and accurate to the best of my knowledge. The specified participant has permission to engage in all activities unless otherwise noted. I have provided RocVentures with all relevant information that may assist in caring for this participant. I agree to promptly notify RocVentures staff in writing of any changes. I understand that failure to provide this information may jeopardize this participants health and safety. For any concerns or questions, I will contact RocVentures management.

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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