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

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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

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