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Climbing Jungle Waiver Form 

ROCK CLIMBING IS A DANGEROUS RECREATIONAL ACTIVITY WITH OBVIOUS INHERENT RISKS  

YOU ARE PARTICIPATING AT YOUR OWN RISK 

Initial Each Box If You Agree: 

I acknowledge that climbing activities have high inherent risks, and by participating in activities at Climbing Jungle I may be injured, and I hereby agree that my use of Climbing Jungle premises and facilities shall be at my own risk. Pursuant to the Civil Liability Amendment Act 2002 No92 (Personal Responsibility) and the Civil Liability Act 2002 No22, Division 4 Assumption of Risk and Division 5 Recreational Activities, Climbing Jungle has very few obligations and liabilities with regard to the provision of recreational adventure activities with such obvious hazards/risks. Meaning… YOU ARE PARTICIPATING AT YOUR OWN RISK. YOU ARE REQUIRED BY LAW TO BE RESPONSIBLE FOR YOUR OWN PERSONAL SAFETY AND THOSE AROUND YOU. 

I Agree

Except where the law imposes liabilities which cannot be excluded, I understand and agree that I will have no claim against any or all of Climbing Jungle, its Directors, employees and agents, for any injuries or losses suffered by me or any other person, or any damage to any personal property whatsoever, whether or not the same be caused or contributed to by an act, omission or negligence of any or all of Climbing Jungle, its directors, employees and agents. 

I Agree

I understand that indoor climbing involves risks that may cause various injuries and that such injuries may result in death or serious disability. I also understand that indoor climbing is physically demanding and in susceptible people climbing may cause panic, hyperventilation, heart attack or other form of malady. 

I Agree

I hereby declare that I am in good physical condition and physically able to undertake climbing activities as described by Climbing Jungle and provided by Climbing Jungle which I elect to undertake. 

I Agree

I agree to comply with the rules for use of Climbing Jungle premises and facilities and comply with the reasonable directions of management and staff of Climbing Jungle concerning such use. 

I Agree

I agree to act in a responsible manner with regard to all climbing activities and with interactions with other patrons, Climbing Jungle staff and any other user or occupier of the Climbing Jungle facility. 

I Agree

I acknowledge that wearing any jewelry and or loose articles (including but not limited to finger rings, wrist bracelets, ties, scarves etc.) of clothing is a potential risk while using this facility and could lead to serious injury and accept this form as formal advice from Climbing Jungle to remove such items while on premise. 

I Agree

I declare that I am not under the influence of alcohol, drugs or any illicit substances. I understand that I am not permitted, now or ever, to use this facility while under the influence of alcohol, drugs or any other illicit substances. 

I Agree

I have read and understand this release and the rules for the use of the facilities of Climbing Jungle, in consideration of being permitted to use the facilities. 

I Agree

I am aware that this waiver is ongoing and will apply to all future occasions I participate in any activities at Climbing Jungle. I acknowledge that this document is contractual and may be relied upon in any proceedings with Climbing Jungle. 

I Agree



First Participant's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle 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.
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*
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 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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