Registration Release Form - Solid Rock Climbers For Christ (Page 4 of 4) in pdf

Registration Release Form - Solid Rock Climbers For Christ Page 4

IF YOU ARE NOT GOING TO WEAR A HELMET AT ALL TIMES WHILE

CLIMBING OR IN THE CLIMBING AREA, THIS FORM IS REQUIRED!

Protective Headgear Refusal Agreement

Please read and be certain you understand the implications of signing

I, FOR MYSELF AND/OR ON BEHALF OF MY CHILD OR LEGAL WARD, HAVE BEEN FULLY

WARNED AND ADVISED BY _________________________ THAT WE SHOULD WEAR A

PROPERLY FITTED HELMET IN ORDER TO REDUCE SOME OR ALL OF OUR HEAD

INJURIES AS THE RESULT OF A FALL OR ANY OTHER OCCURRENCE ASSOCIATED WITH

THIS HAZARDOUS ACTIVITY. WE REALIZE THAT W ARE SUBJECT TO INJURY FROM

THISACTIVITY TO WHICH WE ARE EXPOSING OURSELVES PURELY VOLUNTARILY.

AGAINST THIS ADVICE, WE ARE REFUSING THIS CRITICAL SAFETY PRECAUTION.

I / WE THE UNDERSIGNED, HAVE READ THE FOREGOING STATEMENT AND DO

UNDERSTAND ITS WARNINGS AND ASSUMPTION OF RISKS.

_________________________

___________________________

_________

Signature of Adult

Name of Adult (Please Print)

Date

FOR PARTICIPANTS OF MINORITY AGE: This is to certify that I, as Parent, Guardian, Temporary

Guardian with legal responsibility for this participant do consent and agree not only to his/her

release of all Releasees, but also to release and indemnify the Releasees from any all liabilities

incident to his/her involvement in these programs for myself, my heirs, assigns, and next of kin.

_________________________

___________________________

_________

Signature of parent or adult legal

Name of Parent or adult legal Guardian

Date

Guardian if Participant is a Minor, and

(Please Print)

by their signature, they on my behalf

release all claims that both they and I have

________________________________

___________

Minor Full Name

Date

Registration Release Form - Solid Rock Climbers For Christ Page 4