Training Application Form

Student's Name: *

First NameLast Name

Student's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Phone Number*

Height*

Weight*

Which statement best fits you?

I'm new to window cleaningI've cleaned the windows around my homeI've worked for a cleaning company doing ground workI'm a high-rise cleaner looking to sharpen my skills

From 1-10 what's your experience in using a squeegee or other window cleaning tools?

Have you ever worked for a residential window cleaning company?

YesNo

Do you own any of your own equipment be it window cleaning tools or rope access tools?

YesNo

If Yes, Explain

Do you have any experience in rope access work?

YesNo

If Yes, Explain

From 1-10 what's your experience in rope access?

Describe how you feel about heights

	Yes	No	Comments
Allergies
Asthma or breathing problems
ADD/ADHD
Behavioral Problems
Head Injury, concussions
Hearing Problems or Deafness
Heart Problems
Muscle Problems
Seizures
Spinal Injury
Speech Problems
Surgery
Vision Problems

HIGHRISE U

ACKNOWLEDGEMENT OF RISK, WAIVER OF LIABILITY, AND RELEASE OF LIABILITY

I HEREBY UNDERSTAND, ACKNOWLEDGE, AND AGREE AS FOLLOWS:

1. THAT ROPE ACCESS IS AN INHERENTLY HAZARDOUS AND DANGEROUS ACTIVITY THAT CAN RESULT IN HARM, LOSS DAMAGE, PERSONAL INJURIES, OR DEATH. ____ (Initial)

2. That events and activities related to, assocaited with, or connected with rope access CAN ALSO EXPOSE ME TO HAZARDS AND RISKS, BOTH NATURAL AND ARTIFICIAL, THAT MAY RESULT IN HARM, LOSS, DAMAGE, PERSONAL INJURIES, OR DEATH. _____ (Initial)

3. That my use of the HIGHRISE U TRAINING CENTER (hereinafter, the "SCHOOL"), it's facilities, equipment, or apparatus is entirely voluntarily and with a complete and full understanding that any and all such usage, including, but not limited to climbing, is entirely voluntarilyand with a complete and full understanding that any and all such usage involves hazards and dangers that can result in harm, loss, DAMAGE, PERSONAL INJURY, OR DEATH RESULTING FROM, ARISING OUT OF, OR IN CONNECTION WITH ANY AND ALL SUCH USAGE. _____ (Initial)

4. THAT I WILL OBEY AND COMPLY WITH ALL RULES, REGULATIONS, OR INSTRUCTIONS OF THE SCHOOL OR ITS EMPLOYEES OR AGENTS, and that I have a responsibility to ask questions and clarify any rules, regulations, or instructions if I do not understand, fully comprehend, or have any doubts about any rule, regulation, or instruction. ______ (Initial)

5. That I have an obligation and responsibility to myself, as well as to other users of the SCHOOL, its facilities, equipment, or apparatus, to conduct myself in a safe and reasonable manner, and that I will not use the SCHOOL, its facilites equipment, or apparatus while under the influence of drugs or alcohol or while suffering from or experiencing any condition that might impair me _____ (Initial)

6. That I am responsible for checking and maintaining the safety and good operating condition of any and all personal equipment, gear, or apparel that I may utilize while using the SCHOOL, its facilities, equipment, or apparatus regardless of where or from whom I may have obtained such personal equipment, gear, or apparel; that any equipment, gear, or apparel that I may recieve, rent or borrow from the SCHOOL, or any SCHOOL facilites, equipment, gear, or apparel that I may use, I USE AT MY OWN RISK AND IT IS EXPRESSLY UNDERSTOOD, ACKNOWLEDGED, AND AGREED THAT THE GYM, ITS OFFICERS, DIRECTORS, EMPLOYEES, AND/OR AGENTS SHALL NOT BE LIABLE FOR ANY HARM, LOSS, DAMAGE, PERSONAL INJURY, OR DEATH RESULTING FROM THE USE OF SUCH FACILITIES, EQUIPMENT, GEAR, OR APPAREL. _____ (INITIAL)

7. That in consideration of being permitted to use the SCHOOL, its facilites, equipment, and/or apparatus, for myself and on behalf of my heirs, personal representatives and assigns, I HEREBY WAIVE, RELEASE, AND DISCHARGE FOREVER, HIGHRISE U TRAINING CENTER, AMERICAN CLEANING SYSTEMS LLC, AJH MANAGEMENT LLC., THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AND AGENTS, FROM ANY AND ALL LIABILTIES, CLAIMS, DEMANDS, OR CAUSES OF ACTION WHATSOEVER FOR ANY HARM, LOSS, DAMAGE, PERSONAL INJURIES OR DEATH, DUE TO NEGLIGENCE OR ANY OTHER CAUSE, RESULTING FROM, ARISING OUT OF, OR IN CONNECTION WITH MY USE OF THE GYM, ITS FACILITIES, EQUIPMENT, OR APPARATUS.______ (Initial)

I REPRESENT AND ACKNOWLEDGE THAT I HAVE FULLY READ THIS ACKNOWLEDGEMENT OF RISK, WAIVER OF LIABILITY, AND RELEASE OF LIABILITY AND FULLY UNDERSTAND EACH AND EVERY PROVISION AND THAT I AM VOLUNTARILY EXECUTING THIS AGREEMENT. _____ (Initial

Name (Please Print)

Signature

HIGH-RISE U APPLICATION FORM

Experience

Health History