Visitor Agreement & Release From Liability And Assumption Of Risk For Minors printable pdf download

The Rock Oasis Inc.

Visitor Agreement for Minors (under 18)

(please complete fully – print in blue or black ink only)

(please print)

Name of Child #1: ______

________

_____ Date of Birth: __ __

____

(must be your child)

Name of Child #2: _________ ______

___

___ Date of Birth: __

______

(must be your child)

Name of Child #3: _______________

_____

_ Date of Birth: __

______

(must be your child)

Address: _________________ Postal Code: _______ Telephone Number:

Emergency Contact:

Email: ________________________________

check here if you would like to receive emails

Release from Liability and Assumption of Risk

I understand that there is a risk of serious injury or death from participating in climbing and bouldering. I knowingly and

freely assume all such risks, both known and unknown, even if arising from the negligence of The Rock Oasis Inc.’s staff

or clients and I assume full responsibility for my/my child’s participation. Climbing (top rope climbing, lead climbing and

autobelay climbing), belaying (top rope and lead), bouldering and visiting in the area of climbing walls or bouldering walls

are all dangerous activities.

I/my child will not consume any alcoholic beverages or any other substance which would impair my senses prior to using

or while using the facilities of The Rock Oasis Inc.

I/my child will boulder only in the bouldering area.

When climbing, I/my child will wear a climbing harness for which I/my child assume all responsibility for putting on

correctly. In the roped climbing areas, I/my child will tie into the rope with a figure eight follow through knot for which I/my

child assume all responsibility for tying correctly, and I/my child will be belayed while climbing. I assume full responsibility

for my/my child’s choice in belayers. The Rock Oasis Inc. attempts to provide safe ropes, anchors and belay devices but

will not be responsible for poor judgement by an ill-chosen belayer.

In the auto belay areas, I/my child will wear a climbing harness for which I/my child assume all responsibility for putting on

correctly and I/my child will clip into the autobelay correctly.

I/my child will belay only when knowledgeable and experienced at belaying.

I assume full responsibility for my/my child’s personal belongings and will not hold The Rock Oasis Inc. responsible for

lost or stolen personal belongings.

I have read and fully understand the above and hereby waive and release any liability relating to the use of The Rock

Oasis Inc. I, for myself and on behalf of my heirs assigns, personal representatives, and next of kin, hereby release and

hold harmless The Rock Oasis Inc., their officers, agents and/or employees, other participants, and owners of the

premises used for the activities, with respect to any and all injury, disability or death, whether caused by the negligence of

the releasees or otherwise.

Name of Parent/Legal Guardian: ____________________ Signature: __________________ Date: _________

: ………………………………………………………………………………………..............…………………

Staff use only

1. Lesson:

FI or BO or Refresher

Instructor

Circle:

2. Belay Test: Harness

Tie In

Belay

Bouldering

Autobelay

Pass or Refresher Instructor

Circle:

3. Boulder Only: Bouldering Orientation

Instructor

4. Climb Only: Bouldering Orientation

Autobelay Orientation

Instructor

5. Visitor: Bouldering Orientation

Autobelay Orientation

Instructor

Visitor Agreement & Release From Liability And Assumption Of Risk For Minors

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