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Ascent NB Membership Application

WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT


THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR RIGHTS. It is the purpose of this
agreement to exempt, waive and relieve Ascent New Brunswick (“ANB”) from liability for
personal injury, property damage, and wrongful death.


IN CONSIDERATION of being permitted to participate in any way in the ANB activities, events
or gatherings (“ANB ACTIVITIES”) which may be sponsored, sanctioned, advertised, supervised
or in any way connected directly, indirectly or by implication to ANB, or use ANB equipment I,
for myself and my personal representatives, assigns, heirs, and next of kin:


1. ACKNOWLEDGE, agree, and represent that I realize CLIMBING IS DANGEROUS. I fully
understand that climbing activities involve risks and dangers of serious bodily injury, including
permanent disability, paralysis, and death.


2. UNDERSTAND that pre-existing conditions, medical and otherwise, may make climbing
inappropriate and exceedingly unsafe for some individuals. I certify that I am fit to engage in
ANB activities. If I am in doubt as to my fitness or suitability for climbing, or the fitness or
suitability of the minor under my care for climbing, I will consult a physician before signing this
document.


3. REALIZE that risks and dangers may be caused by my own actions or inactions, the actions
or inactions of others participating in the ANB activities, the conditions in which the ANB
activities take place, the negligence of ANB, etc. I fully accept and assume all such risks and all
responsibility for losses, costs, and damages i incur as a result of my participation or that of the
minor under my care in ANB activities.


4. HEREBY RELEASE FROM ALL LIABILITY, DISCHARGE, AND PROMISE NOT TO SUE
ANB, NOR MAKE DEMANDS OR CLAIMS FOR LOSSES, OR SEEK RESTITUTION FOR
DAMAGES CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE
NEGLIGENCE OF ANB or otherwise, including negligent rescue operations.
I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND
THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT.

 

First Members Name

First Name*

Last Name*
First Members Age Acknowledgment*
First Members Date of Birth*
I certify that I am 18 years of age or older
First Members Information
Has this person previously been a member of Ascent NB?*
No
Yes
Is this person currently a student?*
No
Yes
First Members Signature*
Second Members Name

First Name*

Last Name*
Second Members Date of Birth*
Second Members Information
Has this person previously been a member of Ascent NB?*
No
Yes
Is this person currently a student?*
No
Yes
Third Members Name

First Name*

Last Name*
Third Members Date of Birth*
Third Members Information
Has this person previously been a member of Ascent NB?*
No
Yes
Is this person currently a student?*
No
Yes
Fourth Members Name

First Name*

Last Name*
Fourth Members Date of Birth*
Fourth Members Information
Has this person previously been a member of Ascent NB?*
No
Yes
Is this person currently a student?*
No
Yes
Fifth Members Name

First Name*

Last Name*
Fifth Members Date of Birth*
Fifth Members Information
Has this person previously been a member of Ascent NB?*
No
Yes
Is this person currently a student?*
No
Yes
Sixth Members Name

First Name*

Last Name*
Sixth Members Date of Birth*
Sixth Members Information
Has this person previously been a member of Ascent NB?*
No
Yes
Is this person currently a student?*
No
Yes
Seventh Members Name

First Name*

Last Name*
Seventh Members Date of Birth*
Seventh Members Information
Has this person previously been a member of Ascent NB?*
No
Yes
Is this person currently a student?*
No
Yes
Eighth Members Name

First Name*

Last Name*
Eighth Members Date of Birth*
Eighth Members Information
Has this person previously been a member of Ascent NB?*
No
Yes
Is this person currently a student?*
No
Yes
Ninth Members Name

First Name*

Last Name*
Ninth Members Date of Birth*
Ninth Members Information
Has this person previously been a member of Ascent NB?*
No
Yes
Is this person currently a student?*
No
Yes
Tenth Members Name

First Name*

Last Name*
Tenth Members Date of Birth*
Tenth Members Information
Has this person previously been a member of Ascent NB?*
No
Yes
Is this person currently a student?*
No
Yes
Parent or Guardian's Email Address

Email*
Check to receive information and newsletters
A signed copy of this waiver will be sent to the email address you provide.
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.


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*

Last Name*

Relationship*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Has this person previously been a member of Ascent NB?*
No
Yes
Is this person currently a student?*
No
Yes
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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