Grace Place Rock Climbing Wall Participant Information

Transcription

1 Grace Place Rock Climbing Wall Participant Information INSTRUCTIONS: If you are an adult signing only for yourself please read and complete this document. If you are a parent signing for yourself and/or your children please list yourself and those family members who will be participating. Then please read and complete this document. If parent is completing this document away from Grace Place, please have this document notarized or attach a copy of driver s license. Thank you. Name Spouse Name Children(s) Name(s) Address City State Zip Phone #(s)

2 Grace Place Rock Climbing Wall Participant Agreement, Release and Acknowledgement of Risk INSTRUCTIONS: Adult participants signing only for themselves must read, complete and sign this liability release waiver. All participants under 18 years of age MUST have the waiver completed, initialed and signed by their parents or Legal Guardians. NOTICE: This is a legally binding agreement. Read this carefully before signing. In consideration of the services of Grace Place, its staff, agents, officers, volunteers, participants, and all other persons or entities action in any capacity on their behalf (hereafter collectively referred to as Grace Place), I agree to release and discharge Grace Place, on behalf of myself, my children, parents, guardians, heirs, assigns, personal representative and estate as follows: 1. I acknowledge the inherent extreme risk in rock climbing activities, including those which could occur on artificial climbing walls and result in physical or emotional injury, paralysis, death, or damage to me, property belonging to me, Grace Place and/or to third parties. I realize that these risks cannot be eliminated and include, among other things, climbing or falling off the climbing wall and/or being fallen on by other users; entanglement in ropes; impacting the ground and/or climbing wall; abrasions and/or injury from walls, climbing walls, ropes, loose holds, dropped holds, pads and/or the floor; equipment failure; belay failure; climbing out of control or beyond ones limits; negligence of other climbers, visitors, participants, or other persons who may be present; and/or my own negligence. I understand that there are also unforeseeable accidents which may occur and I assume all risks associated with such accidents. I agree that there are possible accidents which I cannot foresee and I assume all risks associated with such accidents. I agree to pay attention to the condition of the ropes and anchors and to advise staff if I inflict or notice any damage. I agree to abide by all safety rules. I agree that if the staff makes a specific request or gives an instruction to me, I will comply. I agree to use proper belay practices and/or procedures. If I fail to use proper belay practices and/or procedures, the fault is solely mine. I agree that the jobs of the rock climbing staff are difficult and that they seek to create a safe environment by giving adequate warnings and/or instructions, however it is entirely possible that the equipment being used might malfunction, be defective, and/or fail. I agree that the Grace Place staff might be unaware of a participant s fitness or abilities. (initial) 2. I expressly agree and promise to accept and assume all of the risks which exist by reason of my participation in this activity. My participation in this activity is purely voluntary and I elect to participate in spite of the risks. (initial)

3 3. I agree to assume all risks of personal injury, including paralysis and death, that may occur while I am at Grace Place. I hereby voluntarily release, remise and forever discharge and covenant not to sue, Grace Place, its staff, owners, directors, officers, employees, volunteers, wall builders, wall designers, hold manufacturers, lessors, insurers, and agents, from all liability for any such personal injury that I may incur, and any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of Grace Place equipment and/or facilities, including any such claims which allege negligent acts or omission of Grace Place. I understand that this Participant Agreement, Release, Acknowledgement of Risk and Indemnity Agreement includes my claims for personal injury, including death based in total or in part upon the negligent action or inaction of Grace Place, its staff, owners, officers, directors, employees, volunteers, wall builders, wall designers, hold manufacturers, lessors, insurers and agents. (initial) 4. In the event any claim, demand or cause of action is made against Grace Place, its staff, owners, officers, directors, employees, volunteers, wall builders, wall designers, hold manufacturers, lessors, insurers and agents ( Releasees ), by the undersigned or by any minor over who, I have supervisory responsibility at the facilities of Grace Place (whether or not the undersigned is physically present at the time of the occurrence of any injury, damage or loss), I agree to indemnify, hold harmless, and defend the said Releasees, including the payment of reasonable attorneys fees, including indemnify (with payment of costs and a reasonable attorneys fee) for any claim arising in whole or in part from alleged negligent action or inaction on the part of any Releasees. 5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I certify that I have no medical, emotional and/or physical conditions which could interfere with my safety in this activity, or else I am willing to assume and bear the cost of all risks that may be created, directly or indirectly, by any such condition. 6. I understand that indoor rock climbing is not the same as outdoor climbing, and that additional skills are necessary for outdoor climbing that cannot be acquired at Grace Place. I agree to seek qualified instruction before attempting to climb outdoors. 7. This release applies to and binds my personal representative, heirs, and family. I further represent that I have complete and absolute authority to bind, contract for and legally act on behalf of any minor children in my family, and/or listed in this document, and understand and agree that Grace Place relies to its detriment upon this representation and would not allow my minor child to use the rock climbing wall without this representation If a member of my family under the age of 18, or other child that I have authority to legally act on behalf of, participates in any activity at Grace place, whether or not I am present, I make this release and these

4 representations on his or her behalf as well as my own, and I agree to assume responsibility for his or her safety. 8. Should Grace Place or anyone on their behalf, be required to incur attorney s fee and costs to enforce this agreement, I agree to indemnify and hold harmless that party for all such fees and costs. 9. I acknowledge and understand that there is not a substantial impact medium beneath the bouldering, top rope, and lead climbing areas. Falls from any height can result in injury, paralysis, and/or death. 10. Helmet Waiver (Optional, see note): I recognize the dangers inherent in climbing and I am assuming the hazard of this risk upon myself since I wish to climb. I realize I am subject to injury from this activity and that no form of care of preparation can remove all of the danger to which I am exposing myself. I am aware of the safety policy requiring the use of a protective helmet, approved by and marked with UIAA and CE stamps, which could prevent permanent brain damage and/or death in the event of an accident. Against the advice of Grace Place, I am refusing this critical safety precaution. _ Note: those choosing not to initial the Helmet Waiver are required to wear a UIAA and CE approved climbing helmet at all times while climbing and belaying. Those choosing to sign the helmet waiver may wear a non- UIAA approved helmet or go without a helmet. Nearly all bicycle and skate board helmets are not UIAA approved. 11. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Grace Place and any party Releasees on the basis of any claim form which I release them. 12. I understand that this release is a contract, I sign it of my own free will. I also understand that this contract is severable; that if any part of it is held by a court of law to be unenforceable, the rest shall survive. Printed Name: Date: Address: City: State: Zip: SIGNATURE:

5 Parent or Legal Guardian - Additional Indemnification (for participants under 18 years of age) I represent that I have complete and absolute authority to bind contract for and legally act on behalf of the minor children listed below. I understand and agree that Grace Place relies to its detriment upon this representation and would not allow the minor child to use its facility without this representation. In consideration of the minor(s) listed below (hearafter Minor ), being permitted by Grace Place to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless Grace Place and Releasees from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with the use or participation of Minor. Parent or Guardian Printed Name: Signature: Date: Minor Printed Name(s) list all children and ages: Minor Signature(s) (if 14 years or older)

6 Grace Place Rock Climbing Wall General Rules! No smoking! No alcohol or drugs, or persons under the influence of either! Use of profanity will result in immediate loss of access! Rough- housing and running is not permitted! No food or drink is permitted in climbing area! Parent or guardian supervision is required for children under 14 years of age Climbing Rules! All climbers and belayers must read and complete the climber agreement (waiver). Minors, those under the age of 18, must have this completed by parents.! All climbers and belayers must demonstrate proper belay technique to Grace Place staff prior to using the rock climbing wall.! The minimum age for belaying is 14 years of age.! Climbers and belayers must wear UIAA and CE approved helmets, unless helmet waiver is signed.! Belay with manufactured belay devices only.! Climbers must use manufactured climbing harnesses.! Climbers must tie a Figure- 8 Follow Through knot directly into the harness.! All climbers must wear appropriate footwear. No barefoot climbing.! Use only holes and wall for climbing. Do not touch exposed metal, ie. toprope tubes, structural steel, lead anchors, etc.! No topping out. No climbing above toprope tubes or on top of bouldering wall.! Top rope climbers yield to lead climbers.! Leading is available to Grace Place members only, leaders must wear a helmet.! Lead climbers must pass a lead climbing test prior to climbing and belaying leaders.! Climbers should use chalk balls in chalk bags to reduce airborne dust. Loose chalk is not permitted.! Be careful and have fun. Bouldering Rules! Grace Place recommends using at least one spotter when bouldering.! No bouldering above 11 feet in the climbing area. There is a line painted on the climbing wall at 11 feet no part of your body may extend above this line.! Small children should only boulder under the DIRECT supervision of their parents and/or chaperones.! Yield to roped climbers and show courtesy to other boulderers. Grace Place wants to provide a safe and fun environment for all members and spectators. Any persons not complying with all of the above rules will immediately be asked to leave. Grace Place and its staff reserve the right to deny access to anyone for any act deemed inappropriate or unsafe. Signature: Date: