Bouldering Wall Registration Form

Bouldering Registration Form

Please fill out this form to access the climbing wall.
Please select who will be participating

Adult (18+)Minor (Under 18)Adult & Minor
Full Name

First NameLast Name
Guardian's Name

First NameLast Name
Minor's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Guardian's Date of Birth

MonthDayYear
Date
Minor's Date of Birth

MonthDayYear
Date
Phone Number

Country CodeArea CodePhone Number
Email Address
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number

Country CodeArea CodePhone Number
Do you have any medical conditions we should be aware of?
Have you climbed before?

YesNo
I understand that I have the right to obtain independent legal advice prior to signing this form.

In consideration of being permitted to use the climbing wall in this facility, I agree to the following waiver. I also agree to follow safety guidelines and staff instruction. I acknowledge that bouldering has inherent risks and can be a dangerous activity (including risk of serious injury and death) and that the equipment used for safety purposes, including the landing mat, do not eliminate these risks or guarantee my safety. I also recognise that my reckless conduct could put other participants at great risk.

I agree to abide by all facility rules. When using The Dojo Climbing, I will make every possible effort to prevent injury and accident, and pay full attention to ensuring my own safety as well as that of other users. In addition, I understand that The Dojo Climbing will not be held responsible and that I am legally liable to bear the cost of any damages incurred to other users and the facility caused by my own gross negligence.

I agree to only use liquid chalk in this venue.

Minors

All minors under 18 must understand all of the terms and conditions and have a signed waiver from a parent or legal guardian. All boxes must be checked to allow for unsupervised climbing.

Minors who are unable to climb unsupervised must be supervised regardless of age, and all minor under the age of 15 must have a guardian present at each session.
Please check all boxes*

I understand that the bouldering mat doesn't remove the risk of injury.
I understand that failure to exercise due care may result in my, or other participants' injury or death.
I understand that if I have consumed alcohol prior to arriving to the venue or during my session, it is entirely at my own risk. I agree to stop climbing immediately if told to do so by staff and understand that this does not qualify me for a refund.
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Bouldering Registration Form