Waiver
PARTICIPATION AGREEMENT RELEASE, AND ACKNOWLEDGMENT OF RISK
ROCKNASIUM THE CLIMBING GYM 530-757-2902, FAX 530-757-7630
In consideration of the services of ROCKNASIUM, the building owner Olive Drive West a CA G.P., its agents, owners, officers, employees, and all other persons or entities acting in the capacity on its behalf (hereinafter referred to as “ROCKNASIUM”), I hereby agree to release and discharge ROCKNASIUM, on behalf of myself, my heirs, assigns, personal representative and estate as follows:
1. I understand and acknowledge that the activity I am about to engage in bears known risks and unanticipated risks that could result in injury, death, illness, disease, emotional stress, or damage to myself, to property or to third parties. The following describes some but not all, of those risks: climbing on, or falling off, the artificial climbing structures, falling to the ground, on other users or being fallen on by other users, abrasions from the walls, ropes, pads, or the floor, equipment failure, belay failure, or climbing out of control or beyond one’s personal limits.
2. I expressly agree and promise to accept and assume all of the risks existing in the activity. My participation in this activity is purely voluntary, no one is forcing me to participate, and I elect to participate in spite of the risks.
3. I hereby voluntarily release, forever discharge, and agree to hold harmless and indemnify ROCKNASIUM from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributable to the negligent acts or omissions or ROCKNASIUM.
BY SIGNING THIS DOCUMENT, I ACKNOWLEDGE THAT IF ANYONE IS HURT OR PROPERTY IS DAMAGED DURING MY PARTICIPATION IN THIS ACTIVITY, I WILL HAVE NO RIGHT TO MAKE A CLAIM OR FILE A LAWSUIT AGAINST ROCKNASIUM, IT’S AGENTS, OWNERS, OFFICERS, EMPLOYEES, OR ANY OTHER PERSON OR ENTITY ACTING IN ANY CAPACITY ON ITS BEHALF EVEN IT THEY OR ANY OF THEM NEGLIGENTLY CAUSED SUCH INJURY OR DAMAGE.
4. Should ROCKNASIUM, or anyone acting on its behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and reimburse them for such fees and costs.
5. I certify that I have health, accident and liability insurance to cover any bodily injury or property damage I may suffer while participating in this event, or else I agree to bear the costs of such injury or damage myself.
My signature below indicates that I have had sufficient opportunity to read this entire document, that I have read it, and that I understand it, and that I understand it affects my legal rights; I agree to be bound by its terms.
Print Participant’s Name:__________________________________ Birth Date____________
Print Participant’s Name:__________________________________ Birth Date____________
Print Participant’s Name:__________________________________ Birth Date____________
Address:________________________________________
City:____________________ State: _________ Zip:_____________
Phone (_____) - ______________________
Signature of Participant (or Parent):___________________________________________ Date:________________
PARENT’S OR GUARDIAN’S ADDITIONAL INDEMNIFICATION
(Must be completed for participants under the age of 18)
In consideration of _____________________________________________________________(print minor’s name) being permitted by ROCKNASIUM to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless ROCKNASIUM from any and all Claims that are brought by, or on behalf of the Minor, and which are in any way connected with such use or participation by the Minor.
Signature of Parent or Guardian: _________________________________________________ Date:____________
Print Name:___________________________________________________________________
