Unsupervised Climber Registration Form

Climber Registration Form

Please fill out the form carefully
Plas Y Brenin adheres to the British Mountaineering Council Participation statement below:

The BMC recognises that climbing and mountaineering are activities with a danger of risk or personal injury or death. Participants in these activities should be aware of and accept these risks and be responsible for their own actions and involvement.
Full Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Contact Number*
Would you like to be sent information about courses by Plas Y Brenin?*
Conditions of Registration

Once you have read the 'Condition of use' of the climbing wall. You are required to answer the following question by writing either 'yes' or 'No' in the box provided and to sign the declaration at the bottom of the form. Our customers who can give satisfactory answers to these questions will be registered and allowed to climb without supervision.
'Conditions of use of the Climbing Wall'
Please select the registration type:*

Bouldering onlyClimbing & Bouldering
Are you 18 years of age?*
Have you read and understood the 'conditions of use' for the wall?*
Can you put on a harness correctly?*
Can you attach a rope to your harness using a suitable climbing knot?*
Can you use a belay device to secure a falling climber and lower a climber from the wall?*
Do you require instruction in any of the above three techniques?*
Do you understand that failure to exercise due care could result in your injury or death?*
Do you have any questions regarding the application of the conditions of use?*
Do you agree to 'sign in' at reception every time you use the climbing wall?*
Signature*

Clear
Date:*

MonthDayYear
Should be Empty:

Climber Registration Form

Conditions of Registration