Rock And Paddle

Acknowledgement, Assumption, Responsibility and Release of Risk

WARNING: There are significant elements of risk in any adventure, sport or activity associated with rock climbing and incidental weight and fitness training regiments and equipment (referred to herein as “activity”). Although we have taken reasonable steps to provide you with appropriate equipment and/or skilled instruction so you can enjoy an   activity for which you may not be skilled, we wish to remind you this activity is not without risk. Certain risks cannot be eliminated without destroying the unique character of the activity. The same elements that contribute to the unique character of the activity can causes of loss or damage to your equipment, or accidental injury, illness, or in extreme cases trauma or death. We do not want to frighten you or reduce your enthusiasm for this activity, but we do think it is important for you to know in advance what to expect and to be informed of the inherent risks.__________ Initial

ACKNOWLEDGMENT OF RISKS: I acknowledge that the following describes some, but not all of the risks: 1) Slips, trips, falls or painful crashes while using the equipment or on approach to the climbing area; 2) Risk associated with crossing, climbing or down climbing; 3) Misuse of equipment, or failure of equipment; 4) My physical strength, coordination, sense of balance, and ability to follow or give directions while climbing or belaying; 5)Fatigue, chill and/or dizziness, which may diminish my reaction time and increase the risk of accident; 6) Abrasion from or entanglement with equipment or ropes; 7) The presence, actions or falls of other participants. I understand the description of these risks is not complete and that other unknown or unanticipated risks may result in injury, illness, or death. __________  Initial that you understand this warning

EXPRESS ASSUMPTION OF RISK AND RESPONSIBILITY:  In recognition of the inherent risks of the activity which I and any minor children for which I am responsible, will engage, I confirm that I am (we are) physically and mentally capable of participating in the activity and/or using equipment. I/We participate willingly and voluntarily and I assume full responsibility for personal injury, accidents or illness (including death), and any related expenses. I also assume full responsibility for damage to or loss of my/our personal property. I also assume risk for accidents or injury caused by the negligence of my belayer or spotter whether such negligence is comparative or contributory. I am aware of the meaning of the terms “ Unroped Climbing” (aka: “bouldering”), “top rope climbing”, and “lead climbing” and understand the differences between the activities. I accept that lead climbing is most dangerous due to the hazard to both leader and follower. I agree to be “checked out” on climbing and/or belaying skills prior to participation, and to follow rules posted, spoken or understood. I acknowledge that wearing appropriate clothing and footwear are basic safety precautions, and that wearing a UIAA approved helmet may help prevent head and/or neck injuries. _____Initial

 

I assume the risk(s) of personal injury accidents and/or illness, including but not limited to sprains, torn muscles and/or ligaments; fractured or broken bones; eye damage; cuts, wounds, scrapes, abrasions, and/or spinal injuries; insect bite or allergic reaction, shock paralysis, and /or death. __________  Initial that you understand this warning

COVENANT OF GOOD FAITH: I hereby authorize that you, as provider of services will operate under a covenant of good faith and fair dealing, but that you may find it necessary to refuse or terminate the participation of any person you judge to be incapable of meeting the rigors or requirements of participating in the activity. I accept your right to take such actions for the safety of myself and/or other participants. __________  Initial

AUTHORIZATION: I hereby authorize any medical treatment deemed necessary in the event of any injury or illness while participating in the activity. I either have appropriate insurance or, in its absence, agree to pay all costs of rescue and/or medical services as may be incurred on my/our behalf. I agree that any film or photographs of me/us, as participants, become your property and may be used for promotional or commercial purposes. __________  Initial

RELEASE: In consideration of services or property provided, I, for myself and any minor children for which I am Parent, legal guardian or otherwise responsible, any heirs, personal representatives or assigns, do hereby release ROCK AND PADDLE its principals, directors, officers, agents, employees and or volunteers, and each and every land owner, municipal and/or governmental agency upon whose property an activity is conducted, from all liability and waive any claim for damage arising from any cause whatsoever (except that which is the result of gross negligence) _____ Initial

 

I have read and understand the foregoing acknowledgement of risk, assumption of risk and responsibility, and release of liability. I understand that by signing this form I may be waiving valuable legal rights.

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Participants name (print)                                        age           signature                                                  date

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Address                                                                                                                                                   phone number

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In an emergency, notify                                                                                                                          phone number

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If the participant is under 18, the parent or legal guardian must also sign