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Waiver of Liability

(Acknowledgement of Risk Agreement)

 

Climbing, bouldering and abseiling are dangerous recreational activities with obvious risks. All climbers must be willing to take personal responsibility for their own safety and actions and acknowledge the inherent risks involved.

 

YOU ARE PARTICIPATING AT YOUR OWN RISK

 

As acknowledgement of my understanding I agree to initial each statement below and fill in my personal details, sign and declare all information contained herein to be true and correct.

To minimise any risk, I agree to comply with all verbal directions given by management and/or staff. I further agree that I have read, understand and agree to comply with all Rules and Safety Instructions which are displayed throughout this facility. I will ask for an explanation to my satisfaction should I not fully understand any of these instructions, prior to commencing any or all of the above activities.

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 may cause panic, hyperventilation or heart attack.

I Agree

I agree that I have been sufficiently advised of the risks of indoor climbing. I wish to participate and do so entirely at my own risk of injury or bodily harm to myself. I accept full liability for my actions and the actions of any person in my care, whilst utilising this facility.

I Agree

I hereby release Pulse Climbing Pty Ltd, the owner of the premises and all employees, staff and assistants of Pulse Climbing Pty Ltd, or any other persons involved in my participation in indoor climbing at Pulse Climbing from any suit, demand, action or claim for compensation whether for personal injury or damage to property arising from my participation in any or all of the above activities.

I Agree

I acknowledge and accept that should my actions or the actions of those in my care, present a danger or be of a reckless nature to either ourselves or to others at this facility, then the management and /or staff of Pulse Climbing Pty Ltd have the right to request me/us to leave the premises immediately and that we will not be entitled to a refund or recourse of any nature.

I Agree

I am aware that the waiver is ongoing and will apply to all future occasions I participate in indoor climbing at Pulse Climbing. I furthermore acknowledge that this document is contractual and may be relied upon in any proceedings by me, my heirs, executors and assigns.

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
11 Participant's Name

First Name*

Middle Name

Last Name*
11 Participant's Date of Birth
Participant's Address
Address Line1:*
Street address, P.O. box, company name, c/o
Address Line2:
Apartment, suite, unit, building, floor, etc.
City:*
State/Province:*
Zip/Postal:*
Country:*
Parent or Guardian's Email Address

Email*

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

Emergency Contact's Name*

Emergency Contact's Phone Number*
Where did you hear about us?
Word of mouth
Newspaper Ad
Radio Ad
Advertising trailer
Bus Ad
Facebook
Facebook Ad
Google Search
Google Ad
Website
Other
Are you part of a group? (School sport, scouts etc)
Select your group below
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.
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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