Rock Wall Waiver Form - Southern Adventist University printable pdf download

Rock Wall Waiver Form - Southern Adventist University

Rock Wall Waiver Form

Name:

__________________________,

___________________________

Last

First

Note: This form is to be filled out by anyone who participates in

Hulsey Wellness Center’s

the climbing/belaying activities at the

Rock Wall

. Waivers are kept on file for one year.

I, the undersigned user, hereby acknowledge that there are inherent risks involved in

participating at the Hulsey Wellness Center’s Rock Wall. I recognize and understand

these risks and release the Hulsey Wellness Center and the employees thereof from any

liability that may result from these risks, including the risk of physical injury.

I also understand the rules and guidelines of the Hulsey Wellness Center and agree to

abide by these rules for the sake of my personal safety, the safety of other climbers, and

the facility.

I acknowledge that the Hulsey Wellness Center has taken appropriate steps to make the

Rock Wall a safe and enjoyable environment for all its participants.

Participant’s Full Name:

__________________________________________

(please print)

D.O.B.____/____/____

Phone: (

) ______-__________

Signature:_______________________________________________________________

Parent/Guardian Signature:_______________________________________________

(if under age 18)

Date:____/____/____

Signature of H.W.C. Rock Wall Employee:___________________________________

PLEASE READ & SIGN RULES ON BACK!

Rock Wall Waiver Form - Southern Adventist University