AMATEUR ATHLETIC WAIVER AND RELEASE
OF LIABILITY
In consideration of being allowed to participate in any
way in the Peaks Indoor Rock Climbing Club athletic/sport programs, related
events and activities, the undersigned acknowledge, appreciates and agrees
that:
1. ASSUMPTION OF RISK; I hereby acknowledge, accept,
and agree that the sport of rock climbing and the use of PEAKS INDOOR ROCK
CLIMBING CLUB climbing wall involve inherent risks, and while particular
rules, equipment, and personal discipline may reduce this risk, the risk
of serious injury does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both
known and unknown, assume full responsibility for my participation and,
3. I willingly agree to comply with the stated and customary
terms and conditions for participation. If however I observe any unusual
significant hazard during my presence or participation's I will remove
my self from participation and bring such to attention of the nearest official
immediately;
4. I, for my self and on behalf of my heirs, assigns,
personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS
PEAKS INDOOR ROCK CLIMBING CLUB, their officers, officials, agents and/or
employees, other participants, sponsoring agencies, sponsors, advertisers,
and, if applicable, owners and lessors of premises used to conduct the
event ("releasees") with respect to any and all injury, disability, death,
loss or damage to person or property, whether caused by the negligence
of the releasees or otherwise.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION
OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN
UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY
WITHOUT INDUCEMENT.
X______________________
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Participants signature
Date signed
Name, printed clearly
______________________________________
Date of Birth
______________________________________
Address
______________________________________
City/Prov./Post.Code
_______________________________________
Telephone
_______________________________________
In case of Emergency Call
_______________________________________
Have you had any formal training?
_______________________________________
How did you find out about PEAKS? _______________________________________
FOR PARTICIPANTS OF MINORITY AGE
(Under age of 16 at time of registration)
This is to certify that I, as parent/guardian with legal
responsibility for this participant, do consent and agree to his/her release
as provided above of all the Releasees, and, for myself, my heirs, assigns
and next of kin, I release and agree to indemnify the Releasees from any
and all liabilities incident to my minor child's involvement or participation
in these programs as provided above
X_______________________
___________________
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Parent/Guardian's
Emergency phone #
Date signed
signature