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RELEASE AND HOLD HARMLESS FORM

YMCA of Cass and Clay Counties

Schlossman Branch

CLIMBING WALL WAIVER


ADMISSION REQUIREMENTS AND RULES

1. All climbers must sign a release form and fill it out COMPLETELY and LEGIBLY. A parent/legal guardian must sign the release form if the climber is under 18 years of age.

2. All climbers must tie the rope directly in to harness.

3. Climbers must prove their proficiency to belay to a staff BEFORE they will be allowed to belay for others.

4. Climbers under the age of 8 must be accompanied by an adult, and this adult MUST stay in the facility while the climber is using the climbing wall.

5. No running, jumping, yelling, swinging on the ropes or horseplay in the climbing area.

6. Climbers must pay and have their hand stamped at the front desk to access the climbing wall.

7. No food or drinks are allowed in the climbing area.

For your own safety and the safety of other climbers and spectators, you must understand and follow all climbing gym rules. Failure to abide by these rules may result in dismissal from the climbing area. Please sign and date this form after you have read it in its entirety. If you have any questions about these rules, please contact a staff member for clarification.


RELEASE OF ALL CLAIMS, WAIVER OF LIABILITY AND INDEMNIFICATION AGREEMENT

Please initial all indicating you have read, understand, and agree with the following terms. If a climber is under 18 years of age, a parent or legal guardian must sign this form.

In consideration of me or my child being permitted to use the YMCA climbing wall, facilities, services and equipment:

I understand and agree that the use of such facilities and equipment has inherent, unanticipated, and unknown risks and dangers that may cause injuries or death, such as slips, trips, falls or accidents. I expressly assume all risk of injury or death that may be sustained during the use of the climbing wall, facilities and equipment, including those caused or contributed to by the acts or omissions of the YMCA or its officers, directors, agents, and employees, defects in the climbing wall, facility and equipment, the negligence of others, and my own negligence or misuse. 


I hereby release, acquit and discharge the YMCA, its officers, directors, agents, and employees of and from all claims and liability of any kind that may result from or arise out of the use of the climbing wall, facilities and equipment. I covenant and agree that I will not sue or commence any action of any kind against the YMCA, its officers, directors, agents, employees, successors and assigns as a result of my or my child’s use.


I agree to indemnify and hold harmless the YMCA, its officers, directors, agents, employees, successors and assigns, of and from any claims, demands, liabilities, or losses, including attorney’s fees and costs, arising out of my use of the YMCA climbing walls, facilities and equipment.  


 May 2, 2024

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*
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:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Name *

Relationship: *

Phone (cell) *

(Alt. #)

RELEASE OF ALL CLAIMS, WAIVER OF LIABILITY AND INDEMNIFICATION AGREEMENT

I agree to indemnify and hold harmless the YMCA, its officers, directors, agents, and employees, successors and assigns, of an from any claims, demands, liabilities, or losses, including attorney’s fees and costs, made by or on behalf of my child arising out of or during my child’s use of the YMCA climbing wall, facility and equipment. 

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*

Relationship*

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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