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Acknowledgement of Risk Form

1. Participation Statement 

“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.” 

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. If you do not understand any of the terminology or content, please ask a member of staff to clarify. 

2. Conditions of Use 

General Safety 

  • Report to 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 damaged or spinning holds. 
  • Be aware of other climbers around you and how your actions may affect them 
  • Do not distract people whilst they are climbing or belaying 
  • Never stand directly beneath someone who is climbing 
  • If you have children, you must keep them under control and supervise them at all times. Be close enough to control the child’s behaviour at all times 
  • Please make yourself aware of the fire exits and fire assembly points 

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

  • Volumes on the walls are designed to enhance the quality of the climbing experience 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 whilst pregnant can increase the risk posed to mother and 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 
  • Stand back from the climbing walls unless you are belaying or spotting a climber 
  • You take responsibility for adequately maintaining your equipment 
  • Please empty your pockets and remove all jewellery before climbing 

Top-Rope Climbing 

  • Always use a climbing harness to attach yourself to the rope tying the rope directly into the harness using a figure of 8 knot with a stopper. Clipping in with a carabiner is not advised 
  • Do not remove top ropes already in place (unless you are booked on to lead climb *and* understand how to replace a top rope – if you are not able to do so a member of staff will do so but please do not leave the Centre without informing a member of staff that a top rope needs replacing) 
  • It is your responsibility to vet your climbing partner’s ability before they belay you 
  • Ensure you and your climbing partner undertake ‘buddy checks’ prior to each climb 

Lead Climbing 

  • Lead belaying requires a higher degree of skill and understanding from top rope belaying and should only be undertaken if you have received training or are otherwise competent through experience to do so. If you are unsure DO NOT attempt to lead climb. 
  • When using the wall for lead climbing you must provide your own appropriately rated dynamic rope. DO NOT use The Street’s ropes for lead climbing. 
  • If you remove The Street’s top ropes to allow for lead climbing please replace these at the end of your session, or, if you are not able to replace, do not leave the Centre without informing a member of staff that a top rope needs replacing. 

When Belaying 

  • Always abide by good practice when belaying 
  • Always use a belay device attached to your harness with a locking carabiner as per manufacturers’ guidelines. ‘Traditional’ or ‘body’ belaying is not acceptable 
  • To ensure your partner’s safety, always pay attention to what the climber is doing 
  • Always stand as close to the climbing wall as is practicable. Sitting or lying down in not acceptable 

Bouldering 

  • Always climb within your capabilities and descend by down climbing or at the very least, a controlled fall. 
  • Never climb directly above or below another climber 
  • Watch out for falling climbers 
  • Keep the matting clear of personal belongings, this includes bottles, tape, clothing, bags, keys, phones etc. 

3. Our Duty of Care 

The conditions of use of the Street Climbing Walls 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, staff may ask you to leave. 

4. Your Duty of Care 

You have a duty of care to act responsibly towards the other users of the centre (not just those in the climbing area), follow good practice and abide by the conditions of use of the Walls. Statements of Good Practice are posted around the Walls. These describe the accepted methods of use of equipment and the climbing area. 

5. Unsupervised Climbing 

Before you can use the top ropes or lead walls without supervision we expect 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. You are required to register to say you know how to top rope and / or lead, that you are prepared to abide by the Conditions of Use of the wall, and that you understand the risks involved in your participation. Anyone who is not competent to climb unsupervised must be supervised by a competent climber. 

 6. Supervised Climbing 

An adult registered at The Street Climbing Wall as a Competent Climber may supervise up to two novice climbers, as long as they are prepared to take full responsibility for the safety of those people. 

Groups of three or more novices must only be supervised by an instructor 

All children at the Street Climbing Wall must be supervised by an adult unless they have been assessed by the management and registered for unsupervised climbing 

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 an injury to myself or others. 

I confirm that the information below 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. 


Today's Date: July 5, 2025

First Participant's Name
First Name*
Last Name*
Phone*
Select Gender
First Participant's Date of Birth*
Date of Birth
First Participant's Information
Are you 18 years of age? *
Yes
No
Do you understand there is a risk of injury involved? *
Yes
No
Have you read and understood the above information? *
Yes
No

If you intend to lead or top-rope: 

- Can you fit a climbing harness correctly?
Yes
No
- Can you attach a rope to your harness using a suitable climbing knot?
Yes
No
- Can you use a belay device to catch or lower a climber?
Yes
No
Do you require any instruction in any of these areas? *
Yes
No
Do you understand that failure to exercise due care could result in your injury or death? *
Yes
No
Do you understand that the matting does not remove the risk of injury? *
Yes
No
Do you agree to abide by this documents and the conditions of use of the Wall *
Yes
No

Any medical conditions? *
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Second Participant's Information
Are you 18 years of age? *
Yes
No
Do you understand there is a risk of injury involved? *
Yes
No
Have you read and understood the above information? *
Yes
No

If you intend to lead or top-rope: 

- Can you fit a climbing harness correctly?
Yes
No
- Can you attach a rope to your harness using a suitable climbing knot?
Yes
No
- Can you use a belay device to catch or lower a climber?
Yes
No
Do you require any instruction in any of these areas? *
Yes
No
Do you understand that failure to exercise due care could result in your injury or death? *
Yes
No
Do you understand that the matting does not remove the risk of injury? *
Yes
No
Do you agree to abide by this documents and the conditions of use of the Wall *
Yes
No

Any medical conditions? *
Third Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Third Participant's Information
Are you 18 years of age? *
Yes
No
Do you understand there is a risk of injury involved? *
Yes
No
Have you read and understood the above information? *
Yes
No

If you intend to lead or top-rope: 

- Can you fit a climbing harness correctly?
Yes
No
- Can you attach a rope to your harness using a suitable climbing knot?
Yes
No
- Can you use a belay device to catch or lower a climber?
Yes
No
Do you require any instruction in any of these areas? *
Yes
No
Do you understand that failure to exercise due care could result in your injury or death? *
Yes
No
Do you understand that the matting does not remove the risk of injury? *
Yes
No
Do you agree to abide by this documents and the conditions of use of the Wall *
Yes
No

Any medical conditions? *
Fourth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
Are you 18 years of age? *
Yes
No
Do you understand there is a risk of injury involved? *
Yes
No
Have you read and understood the above information? *
Yes
No

If you intend to lead or top-rope: 

- Can you fit a climbing harness correctly?
Yes
No
- Can you attach a rope to your harness using a suitable climbing knot?
Yes
No
- Can you use a belay device to catch or lower a climber?
Yes
No
Do you require any instruction in any of these areas? *
Yes
No
Do you understand that failure to exercise due care could result in your injury or death? *
Yes
No
Do you understand that the matting does not remove the risk of injury? *
Yes
No
Do you agree to abide by this documents and the conditions of use of the Wall *
Yes
No

Any medical conditions? *
Fifth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
Are you 18 years of age? *
Yes
No
Do you understand there is a risk of injury involved? *
Yes
No
Have you read and understood the above information? *
Yes
No

If you intend to lead or top-rope: 

- Can you fit a climbing harness correctly?
Yes
No
- Can you attach a rope to your harness using a suitable climbing knot?
Yes
No
- Can you use a belay device to catch or lower a climber?
Yes
No
Do you require any instruction in any of these areas? *
Yes
No
Do you understand that failure to exercise due care could result in your injury or death? *
Yes
No
Do you understand that the matting does not remove the risk of injury? *
Yes
No
Do you agree to abide by this documents and the conditions of use of the Wall *
Yes
No

Any medical conditions? *
Sixth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
Are you 18 years of age? *
Yes
No
Do you understand there is a risk of injury involved? *
Yes
No
Have you read and understood the above information? *
Yes
No

If you intend to lead or top-rope: 

- Can you fit a climbing harness correctly?
Yes
No
- Can you attach a rope to your harness using a suitable climbing knot?
Yes
No
- Can you use a belay device to catch or lower a climber?
Yes
No
Do you require any instruction in any of these areas? *
Yes
No
Do you understand that failure to exercise due care could result in your injury or death? *
Yes
No
Do you understand that the matting does not remove the risk of injury? *
Yes
No
Do you agree to abide by this documents and the conditions of use of the Wall *
Yes
No

Any medical conditions? *
Seventh Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
Are you 18 years of age? *
Yes
No
Do you understand there is a risk of injury involved? *
Yes
No
Have you read and understood the above information? *
Yes
No

If you intend to lead or top-rope: 

- Can you fit a climbing harness correctly?
Yes
No
- Can you attach a rope to your harness using a suitable climbing knot?
Yes
No
- Can you use a belay device to catch or lower a climber?
Yes
No
Do you require any instruction in any of these areas? *
Yes
No
Do you understand that failure to exercise due care could result in your injury or death? *
Yes
No
Do you understand that the matting does not remove the risk of injury? *
Yes
No
Do you agree to abide by this documents and the conditions of use of the Wall *
Yes
No

Any medical conditions? *
Eighth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
Are you 18 years of age? *
Yes
No
Do you understand there is a risk of injury involved? *
Yes
No
Have you read and understood the above information? *
Yes
No

If you intend to lead or top-rope: 

- Can you fit a climbing harness correctly?
Yes
No
- Can you attach a rope to your harness using a suitable climbing knot?
Yes
No
- Can you use a belay device to catch or lower a climber?
Yes
No
Do you require any instruction in any of these areas? *
Yes
No
Do you understand that failure to exercise due care could result in your injury or death? *
Yes
No
Do you understand that the matting does not remove the risk of injury? *
Yes
No
Do you agree to abide by this documents and the conditions of use of the Wall *
Yes
No

Any medical conditions? *
Ninth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
Are you 18 years of age? *
Yes
No
Do you understand there is a risk of injury involved? *
Yes
No
Have you read and understood the above information? *
Yes
No

If you intend to lead or top-rope: 

- Can you fit a climbing harness correctly?
Yes
No
- Can you attach a rope to your harness using a suitable climbing knot?
Yes
No
- Can you use a belay device to catch or lower a climber?
Yes
No
Do you require any instruction in any of these areas? *
Yes
No
Do you understand that failure to exercise due care could result in your injury or death? *
Yes
No
Do you understand that the matting does not remove the risk of injury? *
Yes
No
Do you agree to abide by this documents and the conditions of use of the Wall *
Yes
No

Any medical conditions? *
Tenth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
Are you 18 years of age? *
Yes
No
Do you understand there is a risk of injury involved? *
Yes
No
Have you read and understood the above information? *
Yes
No

If you intend to lead or top-rope: 

- Can you fit a climbing harness correctly?
Yes
No
- Can you attach a rope to your harness using a suitable climbing knot?
Yes
No
- Can you use a belay device to catch or lower a climber?
Yes
No
Do you require any instruction in any of these areas? *
Yes
No
Do you understand that failure to exercise due care could result in your injury or death? *
Yes
No
Do you understand that the matting does not remove the risk of injury? *
Yes
No
Do you agree to abide by this documents and the conditions of use of the Wall *
Yes
No

Any medical conditions? *
* if climber is aged under 18 please ensure that a parent or guardian completes the following:
I understand there is a risk of injury involved
Yes
No
I understand that failure to exercise due care could result in injury or death?
Yes
No
I agree to the provisions contained within this document and the conditions of use of the wall
Yes
No
I agree to give my consent for my child / ward (named below) to participate in climbing at the Street Rocks Climbing Walls
Yes
No
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*
Last Name*
Phone*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
Are you 18 years of age? *
Yes
No
Do you understand there is a risk of injury involved? *
Yes
No
Have you read and understood the above information? *
Yes
No

If you intend to lead or top-rope: 

- Can you fit a climbing harness correctly?
Yes
No
- Can you attach a rope to your harness using a suitable climbing knot?
Yes
No
- Can you use a belay device to catch or lower a climber?
Yes
No
Do you require any instruction in any of these areas? *
Yes
No
Do you understand that failure to exercise due care could result in your injury or death? *
Yes
No
Do you understand that the matting does not remove the risk of injury? *
Yes
No
Do you agree to abide by this documents and the conditions of use of the Wall *
Yes
No

Any 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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