Balin Scott Miller Foundation Grant Application

Full Name

First NameLast Name

Email Address

example@example.com

Date of Birth

Used to verify age eligibility and determine if a parent/guardian signature is needed.

Full Mailing Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Are you a legal resident of the United States?

Do you confirm that you have a financial need for the grant you are seeking?

Do you confirm that you are 23 years of age or younger at the time of completing this application?

Which grant(s) are you applying for?

Photo of Applicant

Your photo will be part of your application review process and may be used on social media.

1. Tell us about yourself. Are you in school? Are you working? What are the most important things in your life?

Please keep each response under 300 words.0/300

2. Tell us about your relationship to climbing. How did you start?

Please keep each response under 300 words.0/300

3. Tell us about your future goals for climbing.

Please keep each response under 300 words.0/300

4. What specific gear are you seeking? How will the gear allow you to pursue your climbing goals?

Please keep each response under 300 words.0/300

Black Diamond Equipment

Item 1 (Highest Priority)

Item 2

Item 3

Item 4

Black Diamond Equipment

First Choice

Second Choice

7. Between all items selected in gear and shoe requests, which is most needed?

8. Climbing can be inherently dangerous and always involves a certain degree of risk. How will you approach safety while using the climbing gear provided through this grant? Please share any practices, training, guidance, or support you will rely on to climb safely.

Please keep each response under 300 words.0/300

9. This grant is intended for those with financial need. Please describe what receiving this grant means to you.

Please keep each response under 300 words.0/300

10. Optional: Anything else you would like to share.

Please keep each response under 300 words.0/300

PLEASE READ CAREFULLY. THIS SECTION AFFECTS YOUR LEGAL RIGHTS.

1. The Foundation’s Limited Role. The Balin Scott Miller Foundation (the “Foundation”) awards money to help purchase climbing and outdoor gear or may provide such gear directly. The Foundation does not organize, supervise, lead, instruct, or accompany any activity; does not select, fit, inspect, test, maintain, or repair any gear; and makes no representation or warranty, express or implied, regarding the suitability, condition, or fitness for any purpose of any gear purchased with grant funds or provided by the Foundation, or regarding the applicant’s readiness for any objective. All decisions about gear, training, partners, conditions, and whether to attempt or continue any activity rest solely with the applicant.  2. Assumption of Risk. I understand that climbing, mountaineering, and other outdoor activities involve inherent and other risks that cannot be eliminated, including falls, falling rock and ice, avalanche, rockfall, equipment failure or misuse, weather and temperature extremes, exhaustion, remote locations and delayed rescue or medical care, and the acts or omissions of partners and other persons, and that these risks can result in serious injury, permanent disability, or death. I knowingly and voluntarily assume all such risks, whether known or unknown.  3. Release and Covenant Not to Sue. In consideration of being considered for and receiving a grant, I, on behalf of myself and my heirs, personal representatives, and assigns, release, waive, discharge, and covenant not to sue the Foundation and its directors, officers, employees, volunteers, agents, donors, and sponsors (collectively, the “Released Parties”) from any and all claims, demands, damages, liabilities, and causes of action of every kind, including for personal injury, death, or property loss, arising out of or relating to the grant, the purchase or use of any gear, or any activity for which the gear is used, including any such claim arising from the negligence of any Released Party, to the fullest extent permitted by law. This release does not apply to conduct that applicable law does not permit to be released, including gross negligence and willful or intentional misconduct.  4. Consent to Use of Name and Likeness. I grant the Foundation and those it authorizes the irrevocable, royalty-free, worldwide right to record, reproduce, publish, and display my name, likeness, image, voice, photographs, video, and written or oral statements, in any medium now known or later developed, for purposes of promoting, publicizing, and fundraising for the Foundation and its mission. I waive any right to inspect or approve any such use and any claim for compensation, and I waive any claim under Chapter 63.60 RCW or any comparable right of publicity, privacy, or defamation claim arising from a use authorized here.  5. Consent to Disclosure of Personal Information. I understand that the Foundation intends to share my name, age and mailing address with the Foundation’s commercial partners, including Black Diamond Equipment, Ltd. or any of their affiliates (each, a “Partner”) for a Partner’s use in connection with marketing, promotional or outreach communications. I consent to such disclosure. I understand that I may withdraw this consent at any time by written notice to the Foundation, but that withdrawal will not affect disclosures already made in reliance on this consent.  6. Governing Law; Construction. This section is governed by Washington law and is intended to be given the broadest effect permitted by law. If any portion is held unenforceable, that portion shall be modified to the minimum extent necessary to make it enforceable, or if it cannot be, severed, and the remainder shall continue in full force and effect.  7. Applicant’s Acknowledgment. I have read this section, I understand that I am giving up substantial legal rights, including the right to sue, and I sign it freely and voluntarily.

Consent acknowledgements

Applicant Typed Full Legal Name Applicant

First NameMiddle NameLast Name

Applicant Signature

Signature Date

Date

Parent/Guardian Typed Full Legal Name

First NameMiddle NameLast Name

Relationship to Applicant

Parent/Guardian Signature

Signature Date

Date

Balin Scott Miller Foundation Grant Application

Applicant Information and Eligibility

Short Answer Questions

5. Grant-Specific Gear Requests (Maximum 4)

6. Grant-Specific Shoe Requests

Safety and Financial Need

Release of Liability, Assumption of Risk, and Media Consent

Parent/Guardian Consent