Loading...

RELEASE OF LIABILITY AND ASSUMPTION OF RISK

In consideration of the services, and use of the equipment and facilities, of Ozark Climbing Gym, their agents, owners, officers, volunteers, participants, employees, directors, contractors, successors and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as “OCG”), I hereby agree to release, exculpate, and discharge OCG, on behalf of myself, my minor children, my heirs, assigns, personal representatives and estate as follows:

All claims, damages, losses or causes of action for personal injury, emotional distress, death or property damage resulting in whole or in part from my use of the services, equipment or facilities of OCG, including without limitation, because of equipment failure, falling climbers, loose or damaged holds, bad decision maker, or negligence of other participants (collectively, the “Causes”), whether due in whole or in part to negligent acts or omissions of OCC.

I further acknowledge and agree that the Causes are not an exhaustive list of the risks that I may encounter while using OCG’s services or facilities. I agree to accept and assume ALL of the risks of personal injury, death or property damage inherent in these activities, both known and unknown, whether caused or alleged to be caused by the negligent acts or omissions of OCG. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

I agree to indemnify and hold harmless OCG from any and all claims, demands, damages, losses or causes of action of myself or third parties, together with attorney fees, which are in any way connected with my participation in this activity or my use of OCG’s services, equipment or facilities, whether caused or alleged to be caused in whole or in part by negligent acts or omissions of OCG.

I certify that I have no medical or physical conditions that could interfere with my safety in this activity, or I am willing to assume and bear the result of all risks that may be created, directly or indirectly, by any such condition. I hereby authorize any medical treatment deemed necessary in the event of any injury or illness while participating in this activity. I either have appropriate insurance, or agree to pay all costs of rescue and/or medical services as may be incurred on my behalf.

I understand and agree that this document is intended to be as broad and inclusive as is permitted by Arkansas law and that if any portion thereof is held invalid, the balance shall continue in full legal force and effect.

I understand and agree that the laws of the State of Arkansas shall apply to all matters relating to this document and I expressly consent to the exercise of personal jurisdiction in the State of Arkansas.

OCG reserves the right to terminate my use of its services or facilities for any reason. This document shall survive said termination.

I HEREBY CERTIFY THAT I AM EIGHTEEN (18) YEARS OR OLDER, I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF THE RISK AND UNDERSTAND ITS CONTENT. IF APPLICABLE, I AM THE PARENT OR LEGAL GUARDIAN WITH AUTHORITY TO SIGN AND CONSENT TO IT FOR THE PARTICIPATING MINOR.

 

Dated: April 18, 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*
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*
The undersigned parent and natural guardian or legal guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act, and hereby release said parties on behalf of the minor and the parents or legal guardian. I have had sufficient opportunity to read this entire document. I have read and understood it, and I understand this document is binding on me, my children, my parents, my heirs, assigns, personal representative and estate.


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 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!