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Acknowledgement of Risk Form  

 

Adult Climbing

 

Participation statement 

“All climbing and bouldering activities have a risk of serious injury or death. Spectators 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 Spectator to adhere to the conditions of use.”  

 

It is important that you understand this document. There is inherent risk involved with climbing centres and associated activities. By signing this form, you are stating you understand that these risks cannot be completely removed for spectators. If you do not understand any of the terminology or content, ask a member of staff to clarify.  

Conditions of Spectating

General Safety 

- Report to reception on each visit before you climb.  

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

- Spectators are to stay out of the belaying zone and bouldering room at all times.

- Be aware of the climbers around you and how your actions may affect you.  

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

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

- If you have children spectating with you, 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.  

- Follow any instructions given to you by a member of staff or posted on the wall. 



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.  

 

Declarations 

I certify that to the best of my knowledge, I do not suffer from a medical condition that might have the effect of making it more likely that I be involved in an accident that could result in injury to myself or others.  

I also confirm that the above information is correct and if any information changes I will notify the centre.  

 

I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS. 

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
Information
Any relevant medical conditions
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Any relevant medical conditions
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Any relevant medical conditions
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Any relevant medical conditions
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Any relevant medical conditions
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Any relevant medical conditions
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Any relevant medical conditions
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Any relevant medical conditions
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Any relevant medical conditions
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Any relevant medical conditions
Parent or Guardian's Email Address
Email*
Confirm Email*
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PLEASE ANSWER 'YES' OR 'NO' TO THE FOLLOWING QUESTIONS.
Are you over 18 years of age?*
No
Yes
Do you understand that failure to exercise due care could result in your injury or death?*
No
Yes
Do you agree to abide by this document and the conditions of use of the climbing centre?*
No
Yes
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*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Information
Any relevant medical conditions
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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