Loading...

MOUNTAINEERING, ROCK CLIMBING AND INDOOR CLIMBING RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT.

 

Please read and be certain you understand the implications of signing.

Express Assumption of Risk Associated with Mountaineering, Climbing, and Related Activities.

I,


do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with Mountaineering, Rock Climbing and Indoor Climbing activities, transportation of equipment related to the activities, and travelling to and from activity sites in which I am about to engage. Inherent hazards and risks include but are not limited to:

Risk of injury from the activity and equipment utilised in Mountaineering, Rock Climbing and Indoor Climbing is significant including the potential for permanent disability and death.
Possible equipment failure and/or malfunction of my own or others equipment.
My own negligence and/or the negligence of others, including employees, agents, independent contractors or representatives of Skyward Mountaineering, including but not limited to operator error.
Injury to hands, fingers, feet and toes, including but not limited to inflammation and/or strain of muscles ligaments and/or tendons, nerve damage or compression, and broken bones.
Injuries from falling may occur from exposure to high altitude, which may affect judgment and coordination, or from not paying close attention to your climbing or others climbing with or near you.
Broken bones, severe injuries to the head, neck, and back which may result in severe physical impairment or even death.
Discharge of weapons in or near the area of activity.
Cold weather and heat related injuries and illness including but not limited to frost-nip, frost bite, heat exhaustion, heat stroke, sunburn, hypothermia and dehydration.
Exposure to outdoor elements, including but not limited to avalanche, rock fall, inclement weather, thunder and lighting, severe and or varied wind, temperature or weather conditions.
Attack by or encounter with insects, reptiles, and/or animals.
Accidents or illness occurring in remote places where there are no available medical facilities.
Fatigue, chill, and/or dizziness, which may diminish my/our reaction time and increase the risk of accident.
My sense of balance, physical coordination, and ability to follow instructions.

*I understand the description of these risks is not complete and that unknown or unanticipated risks may result in injury, illness, or death.

 

Release of Liability, Waiver of Claims and Indemnity Agreement

In consideration for being permitted to participate in any way in Mountaineering, Rock Climbing and Indoor Climbing and related activities, I hereby agree, acknowledge and appreciate that:

I HEREBY RELEASE AND HOLD HARMLESS WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE, the following named persons or entities, herein referred to as releasees.

Skyward Mountaineering and all representatives

Owner (Company and/or Person)

To release the releasees, their officers, directors, employees, representatives, agents, and volunteers, from liability and responsibility whatsoever and for any claims or causes of action that I, my estate, heirs, survivors, executors, or assigns may have for personal injury, property damage, or wrongful death arising from the above activities whether caused by active or passive negligence of the releasees or otherwise. By executing this document, I agree to hold the releasees harmless and indemnify them in conjunction with any injury, disability, death, or loss or damage to person or property that may occur as a result of engaging in the above activities.
By entering into this Agreement, I am not relying on any oral or written representation or statements made by the releasees, other than what is set forth in this Agreement.

This release shall be binding to the fullest extent permitted by law. If any provision of this release is found to be unenforceable, the remaining terms shall be enforceable.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND I FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

 

I Agree

S/

April 19, 2024

Signature of Adult Participant

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Health Information
FITNESS LEVEL: Please rate your current level of fitness *
Excellent: I can carry a 50 pound pack all day, uphill, with rests.
Good: I can walk up several flights of stairs, and walk at least 4 miles.
Fair: I'm capable of climbing several flights of stairs and walk several miles, but with a great deal of effort and many rests.
Poor: I can't perform any of the above tasks.

Please describe your current conditioning and exercise program.

Please describe your relevant climbing, mountaineering, skiing, or other outdoor experience including your most recent climbs of relevance.
MEDICAL INFORMATION: Please check the box if you have had any of the following within the last three years. If you checked any of the boxes below, please elaborate in the space provided below.
Altitude Related Illness
Broken Bones
Severe Sprains
Shoulder or Neck Problems
Back Problems
Foot or Ankle Problems
Leg or Knee Problems
Arm or Hand Problems
Gastrointestinal Problems
Urinary Tract Problems
Sensitivity to Iodine
Heat or Cold Injury or Intolerance
Diagnosed Mental Illness
Severe Anxiety or Depression
High Blood Pressure
Heart Disease
History of Seizures
Asthma
Diabetes
Chronic Headaches or Migraines
Shortness of Breath
Chest Pain
Hospitalization in the past year
Smoke Tobacco
On Prescription Medication
Uncorrected Vision or Hearing Impairment
Allergies or Sensitivities
Women Only: Currently Pregnant

Please elaborate on any above checked boxes.
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Health Information
FITNESS LEVEL: Please rate your current level of fitness *
Excellent: I can carry a 50 pound pack all day, uphill, with rests.
Good: I can walk up several flights of stairs, and walk at least 4 miles.
Fair: I'm capable of climbing several flights of stairs and walk several miles, but with a great deal of effort and many rests.
Poor: I can't perform any of the above tasks.

Please describe your current conditioning and exercise program.

Please describe your relevant climbing, mountaineering, skiing, or other outdoor experience including your most recent climbs of relevance.
MEDICAL INFORMATION: Please check the box if you have had any of the following within the last three years. If you checked any of the boxes below, please elaborate in the space provided below.
Altitude Related Illness
Broken Bones
Severe Sprains
Shoulder or Neck Problems
Back Problems
Foot or Ankle Problems
Leg or Knee Problems
Arm or Hand Problems
Gastrointestinal Problems
Urinary Tract Problems
Sensitivity to Iodine
Heat or Cold Injury or Intolerance
Diagnosed Mental Illness
Severe Anxiety or Depression
High Blood Pressure
Heart Disease
History of Seizures
Asthma
Diabetes
Chronic Headaches or Migraines
Shortness of Breath
Chest Pain
Hospitalization in the past year
Smoke Tobacco
On Prescription Medication
Uncorrected Vision or Hearing Impairment
Allergies or Sensitivities
Women Only: Currently Pregnant

Please elaborate on any above checked boxes.
Second Participant's Signature*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Health Information
FITNESS LEVEL: Please rate your current level of fitness *
Excellent: I can carry a 50 pound pack all day, uphill, with rests.
Good: I can walk up several flights of stairs, and walk at least 4 miles.
Fair: I'm capable of climbing several flights of stairs and walk several miles, but with a great deal of effort and many rests.
Poor: I can't perform any of the above tasks.

Please describe your current conditioning and exercise program.

Please describe your relevant climbing, mountaineering, skiing, or other outdoor experience including your most recent climbs of relevance.
MEDICAL INFORMATION: Please check the box if you have had any of the following within the last three years. If you checked any of the boxes below, please elaborate in the space provided below.
Altitude Related Illness
Broken Bones
Severe Sprains
Shoulder or Neck Problems
Back Problems
Foot or Ankle Problems
Leg or Knee Problems
Arm or Hand Problems
Gastrointestinal Problems
Urinary Tract Problems
Sensitivity to Iodine
Heat or Cold Injury or Intolerance
Diagnosed Mental Illness
Severe Anxiety or Depression
High Blood Pressure
Heart Disease
History of Seizures
Asthma
Diabetes
Chronic Headaches or Migraines
Shortness of Breath
Chest Pain
Hospitalization in the past year
Smoke Tobacco
On Prescription Medication
Uncorrected Vision or Hearing Impairment
Allergies or Sensitivities
Women Only: Currently Pregnant

Please elaborate on any above checked boxes.
Third Participant's Signature*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Health Information
FITNESS LEVEL: Please rate your current level of fitness *
Excellent: I can carry a 50 pound pack all day, uphill, with rests.
Good: I can walk up several flights of stairs, and walk at least 4 miles.
Fair: I'm capable of climbing several flights of stairs and walk several miles, but with a great deal of effort and many rests.
Poor: I can't perform any of the above tasks.

Please describe your current conditioning and exercise program.

Please describe your relevant climbing, mountaineering, skiing, or other outdoor experience including your most recent climbs of relevance.
MEDICAL INFORMATION: Please check the box if you have had any of the following within the last three years. If you checked any of the boxes below, please elaborate in the space provided below.
Altitude Related Illness
Broken Bones
Severe Sprains
Shoulder or Neck Problems
Back Problems
Foot or Ankle Problems
Leg or Knee Problems
Arm or Hand Problems
Gastrointestinal Problems
Urinary Tract Problems
Sensitivity to Iodine
Heat or Cold Injury or Intolerance
Diagnosed Mental Illness
Severe Anxiety or Depression
High Blood Pressure
Heart Disease
History of Seizures
Asthma
Diabetes
Chronic Headaches or Migraines
Shortness of Breath
Chest Pain
Hospitalization in the past year
Smoke Tobacco
On Prescription Medication
Uncorrected Vision or Hearing Impairment
Allergies or Sensitivities
Women Only: Currently Pregnant

Please elaborate on any above checked boxes.
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Health Information
FITNESS LEVEL: Please rate your current level of fitness *
Excellent: I can carry a 50 pound pack all day, uphill, with rests.
Good: I can walk up several flights of stairs, and walk at least 4 miles.
Fair: I'm capable of climbing several flights of stairs and walk several miles, but with a great deal of effort and many rests.
Poor: I can't perform any of the above tasks.

Please describe your current conditioning and exercise program.

Please describe your relevant climbing, mountaineering, skiing, or other outdoor experience including your most recent climbs of relevance.
MEDICAL INFORMATION: Please check the box if you have had any of the following within the last three years. If you checked any of the boxes below, please elaborate in the space provided below.
Altitude Related Illness
Broken Bones
Severe Sprains
Shoulder or Neck Problems
Back Problems
Foot or Ankle Problems
Leg or Knee Problems
Arm or Hand Problems
Gastrointestinal Problems
Urinary Tract Problems
Sensitivity to Iodine
Heat or Cold Injury or Intolerance
Diagnosed Mental Illness
Severe Anxiety or Depression
High Blood Pressure
Heart Disease
History of Seizures
Asthma
Diabetes
Chronic Headaches or Migraines
Shortness of Breath
Chest Pain
Hospitalization in the past year
Smoke Tobacco
On Prescription Medication
Uncorrected Vision or Hearing Impairment
Allergies or Sensitivities
Women Only: Currently Pregnant

Please elaborate on any above checked boxes.
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Health Information
FITNESS LEVEL: Please rate your current level of fitness *
Excellent: I can carry a 50 pound pack all day, uphill, with rests.
Good: I can walk up several flights of stairs, and walk at least 4 miles.
Fair: I'm capable of climbing several flights of stairs and walk several miles, but with a great deal of effort and many rests.
Poor: I can't perform any of the above tasks.

Please describe your current conditioning and exercise program.

Please describe your relevant climbing, mountaineering, skiing, or other outdoor experience including your most recent climbs of relevance.
MEDICAL INFORMATION: Please check the box if you have had any of the following within the last three years. If you checked any of the boxes below, please elaborate in the space provided below.
Altitude Related Illness
Broken Bones
Severe Sprains
Shoulder or Neck Problems
Back Problems
Foot or Ankle Problems
Leg or Knee Problems
Arm or Hand Problems
Gastrointestinal Problems
Urinary Tract Problems
Sensitivity to Iodine
Heat or Cold Injury or Intolerance
Diagnosed Mental Illness
Severe Anxiety or Depression
High Blood Pressure
Heart Disease
History of Seizures
Asthma
Diabetes
Chronic Headaches or Migraines
Shortness of Breath
Chest Pain
Hospitalization in the past year
Smoke Tobacco
On Prescription Medication
Uncorrected Vision or Hearing Impairment
Allergies or Sensitivities
Women Only: Currently Pregnant

Please elaborate on any above checked boxes.
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Health Information
FITNESS LEVEL: Please rate your current level of fitness *
Excellent: I can carry a 50 pound pack all day, uphill, with rests.
Good: I can walk up several flights of stairs, and walk at least 4 miles.
Fair: I'm capable of climbing several flights of stairs and walk several miles, but with a great deal of effort and many rests.
Poor: I can't perform any of the above tasks.

Please describe your current conditioning and exercise program.

Please describe your relevant climbing, mountaineering, skiing, or other outdoor experience including your most recent climbs of relevance.
MEDICAL INFORMATION: Please check the box if you have had any of the following within the last three years. If you checked any of the boxes below, please elaborate in the space provided below.
Altitude Related Illness
Broken Bones
Severe Sprains
Shoulder or Neck Problems
Back Problems
Foot or Ankle Problems
Leg or Knee Problems
Arm or Hand Problems
Gastrointestinal Problems
Urinary Tract Problems
Sensitivity to Iodine
Heat or Cold Injury or Intolerance
Diagnosed Mental Illness
Severe Anxiety or Depression
High Blood Pressure
Heart Disease
History of Seizures
Asthma
Diabetes
Chronic Headaches or Migraines
Shortness of Breath
Chest Pain
Hospitalization in the past year
Smoke Tobacco
On Prescription Medication
Uncorrected Vision or Hearing Impairment
Allergies or Sensitivities
Women Only: Currently Pregnant

Please elaborate on any above checked boxes.
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Health Information
FITNESS LEVEL: Please rate your current level of fitness *
Excellent: I can carry a 50 pound pack all day, uphill, with rests.
Good: I can walk up several flights of stairs, and walk at least 4 miles.
Fair: I'm capable of climbing several flights of stairs and walk several miles, but with a great deal of effort and many rests.
Poor: I can't perform any of the above tasks.

Please describe your current conditioning and exercise program.

Please describe your relevant climbing, mountaineering, skiing, or other outdoor experience including your most recent climbs of relevance.
MEDICAL INFORMATION: Please check the box if you have had any of the following within the last three years. If you checked any of the boxes below, please elaborate in the space provided below.
Altitude Related Illness
Broken Bones
Severe Sprains
Shoulder or Neck Problems
Back Problems
Foot or Ankle Problems
Leg or Knee Problems
Arm or Hand Problems
Gastrointestinal Problems
Urinary Tract Problems
Sensitivity to Iodine
Heat or Cold Injury or Intolerance
Diagnosed Mental Illness
Severe Anxiety or Depression
High Blood Pressure
Heart Disease
History of Seizures
Asthma
Diabetes
Chronic Headaches or Migraines
Shortness of Breath
Chest Pain
Hospitalization in the past year
Smoke Tobacco
On Prescription Medication
Uncorrected Vision or Hearing Impairment
Allergies or Sensitivities
Women Only: Currently Pregnant

Please elaborate on any above checked boxes.
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Health Information
FITNESS LEVEL: Please rate your current level of fitness *
Excellent: I can carry a 50 pound pack all day, uphill, with rests.
Good: I can walk up several flights of stairs, and walk at least 4 miles.
Fair: I'm capable of climbing several flights of stairs and walk several miles, but with a great deal of effort and many rests.
Poor: I can't perform any of the above tasks.

Please describe your current conditioning and exercise program.

Please describe your relevant climbing, mountaineering, skiing, or other outdoor experience including your most recent climbs of relevance.
MEDICAL INFORMATION: Please check the box if you have had any of the following within the last three years. If you checked any of the boxes below, please elaborate in the space provided below.
Altitude Related Illness
Broken Bones
Severe Sprains
Shoulder or Neck Problems
Back Problems
Foot or Ankle Problems
Leg or Knee Problems
Arm or Hand Problems
Gastrointestinal Problems
Urinary Tract Problems
Sensitivity to Iodine
Heat or Cold Injury or Intolerance
Diagnosed Mental Illness
Severe Anxiety or Depression
High Blood Pressure
Heart Disease
History of Seizures
Asthma
Diabetes
Chronic Headaches or Migraines
Shortness of Breath
Chest Pain
Hospitalization in the past year
Smoke Tobacco
On Prescription Medication
Uncorrected Vision or Hearing Impairment
Allergies or Sensitivities
Women Only: Currently Pregnant

Please elaborate on any above checked boxes.
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Health Information
FITNESS LEVEL: Please rate your current level of fitness *
Excellent: I can carry a 50 pound pack all day, uphill, with rests.
Good: I can walk up several flights of stairs, and walk at least 4 miles.
Fair: I'm capable of climbing several flights of stairs and walk several miles, but with a great deal of effort and many rests.
Poor: I can't perform any of the above tasks.

Please describe your current conditioning and exercise program.

Please describe your relevant climbing, mountaineering, skiing, or other outdoor experience including your most recent climbs of relevance.
MEDICAL INFORMATION: Please check the box if you have had any of the following within the last three years. If you checked any of the boxes below, please elaborate in the space provided below.
Altitude Related Illness
Broken Bones
Severe Sprains
Shoulder or Neck Problems
Back Problems
Foot or Ankle Problems
Leg or Knee Problems
Arm or Hand Problems
Gastrointestinal Problems
Urinary Tract Problems
Sensitivity to Iodine
Heat or Cold Injury or Intolerance
Diagnosed Mental Illness
Severe Anxiety or Depression
High Blood Pressure
Heart Disease
History of Seizures
Asthma
Diabetes
Chronic Headaches or Migraines
Shortness of Breath
Chest Pain
Hospitalization in the past year
Smoke Tobacco
On Prescription Medication
Uncorrected Vision or Hearing Impairment
Allergies or Sensitivities
Women Only: Currently Pregnant

Please elaborate on any above checked boxes.
Tenth Participant's Signature*
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:*
Parent or Guardian's Email Address

Email*

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

First Name*

Last Name*

Emergency Contact's Phone Number*
Activities
Which activity are you participating in?*
FOR PARTICIPANTS OF MINORITY AGE: This is to certify that I, as Parent, Guardian, Temporary Guardian with legal responsibility for this participant, do consent and agree not only to his/her release of all Releasees, but also to release and indemnify the Releasees from any and all liabilities incident to his/her involvement in these programs for myself, my heirs, assigns, and next of kin. If Participant is a Minor, and by their signature, they on my behalf release all claims that both they and I have.


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 Health Information
FITNESS LEVEL: Please rate your current level of fitness *
Excellent: I can carry a 50 pound pack all day, uphill, with rests.
Good: I can walk up several flights of stairs, and walk at least 4 miles.
Fair: I'm capable of climbing several flights of stairs and walk several miles, but with a great deal of effort and many rests.
Poor: I can't perform any of the above tasks.

Please describe your current conditioning and exercise program.

Please describe your relevant climbing, mountaineering, skiing, or other outdoor experience including your most recent climbs of relevance.
MEDICAL INFORMATION: Please check the box if you have had any of the following within the last three years. If you checked any of the boxes below, please elaborate in the space provided below.
Altitude Related Illness
Broken Bones
Severe Sprains
Shoulder or Neck Problems
Back Problems
Foot or Ankle Problems
Leg or Knee Problems
Arm or Hand Problems
Gastrointestinal Problems
Urinary Tract Problems
Sensitivity to Iodine
Heat or Cold Injury or Intolerance
Diagnosed Mental Illness
Severe Anxiety or Depression
High Blood Pressure
Heart Disease
History of Seizures
Asthma
Diabetes
Chronic Headaches or Migraines
Shortness of Breath
Chest Pain
Hospitalization in the past year
Smoke Tobacco
On Prescription Medication
Uncorrected Vision or Hearing Impairment
Allergies or Sensitivities
Women Only: Currently Pregnant

Please elaborate on any above checked boxes.
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!