Rock Climbing Gym Waiver
Participant Information
Full Name
Date of Birth
Address
Phone Number
Email
Emergency Contact
Name
Phone Number
Assumption of Risk
I have read and understand the above information.
Release of Liability
I agree to the release of liability.
Medical Information
Please list any medical conditions or allergies
Signature
Participant Signature
Date
If participant is under 18:
Parent/Guardian Name
Parent/Guardian Signature
Date