CLIMBING CLUB

CLIMBING CLUB

Reach Outdoors @ Parkfield Climbing Centre
CONTACT DETAILS

At Reach Outdoors we pride ourselves in delivering high quality and safe sessions, tailored to meet the individual and groups needs. For us to do this we need certain personal information such as contact details and medical information from you and/or your group. We may also collect your personal information for marketing purposes to inform you of future activities. We will not contact you for marketing purposes by email, phone or text message unless you have given your prior consent. For more information regarding how we manage our clients personal information, please visit the Reach Outdoors website to view our Privacy Policy.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
I give consent for Reach Outdoors Ltd to:

include me in marketing images and use those images for advertising in public and social media platformsI do not wish for information/ image to be used for marketing or advertising
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

DayMonthYear
Date
Who is completing the form?

I am 18 year old or over at the time of completing this form.Unsupervised Participant: 17 years olds ( Parent/ guardian must read and complete this form on behalf of participant and give signed consent for child to participate in the below activity ).Supervised Participant: 4-17 years old ( Parent/ guardian must complete this form on behalf of participant and give signed consent for child to participate in the below activity. Participant will require adult supervision at all times whilst within the climbing wall and facility areas).Supervised Participant: 18 year old or over
Emergency Contact

NameRelationship Phone Number
MEDICAL INFORMATION
Indoor climbing is a physically demanding activity that may involve climbing up and across an artificial wall, controlled falling and descending from height as well as supporting and securing others at height. This requires a moderate level of fitness mobility and concentration. Your safety is paramount to Reach Outdoors and therefore we need to be aware of any medical information relevant to your participation. Please select and provide further detail if you have any of the following conditions; and / or any other injury or illness which may affect your participation.

Have a heart/respiratory condition (e.g angina/asthma)DiabeticEpileptic / seizuresRecently had an operationRecurring skeletal/musculature problemsTaking medicationAny allergiesPregnant
Details of medical conditions/ injuries/ illness
ACKNOWLEDGEMENT OF / AND ASSUMPTION OF RISK AND RELEASE FORM

Please read the following information carefully. It is important to fully understand the risk and responsibility to yourself and others when climbing. Only sign to following terms if you fully understand, accept and agree. If you need any help understanding this document or have any questions regarding the terms and conditions of this document, please contact our main office on 01803 524 950.
General Rules and Regulations
- All climbers must sign an Acknowledgement of and Assumption of Risk and Release Form prior to their first climbing visit to an ‘Climbing Club Session'. Once signed this will be filed and will expire after 1 year. (If under 18, a parent or legal guardian must sign it on their behalf.)
- No one may climb while under the influence of controlled substances.
- All climbers must wear a helmet or sign a helmet waiver. (If under 18, a parent or legal guardian must sign.) Reach Outdoors recommends that all climbers wear a helmet.
- Customers must respect and obey all requests made by Reach Outdoors staff.
- Food and drinks are permitted, but at least 2m away from the climbing areas.
- Any customer disregarding any rules/regulations is subject to loss of climbing privileges with no refund.
- All customers must stay out of the sports hall, unless accessing toilet facilities.
Bouldering Rules and Regulations
- Never sit, stand, or walk under a climber.
- Correct spotting technique to be used when supporting boulders is recommended by Reach Outdoors.
- Hands not to exceed 2.5m from the ground.
Top Roping and Lead Climbing Rules and Regulations
- Do not step on ropes or webbing.
- Never sit, stand, or walk under climbers.
- Never hang or swing on the ropes.
- Do not put fingers into bolt attachment holes or bolt hanger rings.
- Never throw karabiners, belay devices, helmets, or any other gear.
- Everyone over the age of 16 must know how to tie a rethreaded figure eight knot, a stopper knot, set up a belay, AND belay a climber correctly to use this area. (Must be Belay Certified)
- Anyone ages 4-16 must be supervised by someone who is Belay Certified to use this area.
- ALL climbers must be Lead Certified to lead belay and/or lead climb at Reach Outdoors, Parkfield.
- When tying in, a double figure eight knot with a stopper knot must be used. (NO clipping in)
- Use of personal ropes for lead climb is at the risk of the customer. Ropes must be dry and clean.
- All personal climbing gear is at the risk of the customer. It is advised to have full knowledge of the history of your personal kit.
- ALL belayers must belay through their harness and be anchored if there is a large weight difference.
- ALL belayers must be standing and wear appropriate footwear.
- Belayers must lower climbers at a slow rate, and climbers are advised not to bounce down the wall due to the increased risk during descent.
- Respect the space of other climbers and belayers.
- ALL climbers are required to follow the Bouldering Guidelines for this area.
- Only certified instructors of Reach Outdoors are permitted to teach belaying.
I First Name Last Name have read / listened to the rules and regulations of Reach Outdoors Ltd at Parkfield, and agree that I will accept and abide by the rules, which are intended to provide a safe climbing environment. I also agree to be completely responsible for the condition of my gear that I use in the gym and if it fails to perform properly, I am solely responsible for this occurrence.
This Acknowledge and Assumption of Risk and Release shall be binding upon heirs and assigns. I have read and understand the above:

Clear
I   First Name   Last Name am aware that indoor rock climbing and training in an indoor gym are dangerous activities, which carry significant risk of serious personal injury or death. I am participating in these activities with knowledge of the dangers involved and hereby agree to accept any and all risks of injury or death.

I   First Name   Last Name   acknowledge and agree that I am responsible for my own safety and anyone under my supervision. I accept that Reach Outdoors Ltd, it's Directors and employees are not responsible for my safety or the safety of anyone under my supervision. I agree to accept all responsibility for the risks and hazards, which may occur whether they are known or unknown.

I am fully aware that there are risks and hazards when participating in the activity stipulated above. I   First Name   Last Name hereby agree to waive, release, and discharge any and all claims for damages, death, personal injury, or property damage which I may have or which may hereafter accrue to me as a result of my participation in the above activities, against any person or entities mentioned above, regardless whether such injury or damage was foreseeable.
This Acknowledge and Assumption of Risk and Release shall be binding upon heirs and assigns. I have read and understand the above:

Clear
Signed by Parent / Guardian

Full NameDate
Parent / Guardian Consent

By signing this Acknowledgment of, Assumption of Risk and Release Form as parent/guardian, I acknowledge that I have read the above release and fully understand its contents. I agree to be bound by the terms of the release and understand that any and all risk, whether known or unknown, are expressly assumed by me, and all claims, whether known or unknown, are expressly waived in advance.
Signature of Parent / Guardian if participant is under the age of 18 years

Clear
Signed by Parent / Guardian

Full NameRelationship Date
Should be Empty:

CLIMBING CLUB

CONTACT DETAILS

MEDICAL INFORMATION

ACKNOWLEDGEMENT OF / AND ASSUMPTION OF RISK AND RELEASE FORM