Loading...

U18s

Supervision Form - Rainbow Rocket

IMPORTANT - READ THIS FIRST

There are three stages to be signed off to supervise a novice at Rainbow Rocket

Step 1: Complete an Acknowledgement of Risk registration form for all participants

Step 2: Prove competency through an Adult Supervisor Assessment with a Duty Manager

Step 3: Complete this novice supervision form for each person you will be supervising

Anyone who is not competent to climb unsupervised must be supervised by a registered supervisor. Supervisors must be prepared to take full responsibility for the safety of those they are supervising and complete the forms referenced above before any activity starts. 

An adult (18+) who has registered at the centre, and proved competency (through our Adult Supervisor Assessment), may supervise up to two junior climbers. All children in the centre must be supervised by an adult unless they have been assessed by the management and registered for unsupervised climbing.

For our full novice supervision policy, please visit our website. 

Supervisors must take their responsibilities seriously. They must accept, on behalf of minors or novices they are supervising, the ABC participation statement which is as follows:

“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.”

Do you agree to the statements above?

I Agree

First Novice Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Novice Date of Birth*
Supervisor Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Supervisor Questions
If you are not the Parent or Legal Guardian, do you certify that you have obtained permission to act in 'loco parentis' for the Participant? *
I agree
Supervisors must ensure that those they are supervising adhere to the terms and conditions of use that are found at reception and on their registration/acceptance of risk forms. *
I agree
Do you agree to be responsible for the safety and behaviour of those you are supervising during your visit? *
I agree
Do you understand that failure to supervise properly may result in serious injury or death? *
I agree
Do you understand that failure to supervise properly may result in your climbing session being stopped? *
I agree
Do you agree to abide by Rainbow Rocket's novice supervision policy? *
I agree

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.  If you are not the Parent or Legal Guardian, you must have obtained permission to act in 'loco parentis' for the Participant. 

'Loco parentis' means "in place of the parent", meaning you are responsible for decisions related to someone's child on behalf of the parent.



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.
Supervisor Name

First Name*

Last Name*

Relationship*

Phone*
Supervisor Date of Birth*
Supervisor 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! and  Rock Gym Pro