Indoor Rock Climbing Waiver Form

Wellington Health and Fitness Club

Indoor Rock Climbing Waiver Form

Personal Information Full Name:

Date of Birth:

Address:

Phone Number:

Email:

Acknowledgment of Risk

I, the undersigned, understand that indoor rock climbing is a potentially hazardous activity that carries inherent risks, including but not limited to falls, equipment failure, and physical injury. I acknowledge that while the staff at Wellington Health and Fitness Club will take all reasonable precautions to ensure my safety, there are risks that cannot be eliminated.

I confirm that I have read and understood the British Mountaineering Council’s Participation Statement: “The BMC recognises that climbing and mountaineering are activities with a danger of personal injury or death. Participants in these activities should be aware of and accept these risks and be responsible for their own actions and involvement.”

I voluntarily assume all risks associated with indoor rock climbing and agree to comply with all safety instructions and guidelines provided by the staff at Wellington Health and Fitness Club.

Signature:

Date:

Medical Information Do you have any medical conditions that we should be aware of? (e.g., asthma, diabetes, heart conditions)

Are you currently taking any medications? If so, please list them:

Do you have any allergies? If so, please list them:

Emergency Contact Information Name of Emergency Contact:

Relationship to Participant:

Phone Number of Emergency Contact:

Consent for Minors (if applicable) Name of Parent/Guardian:

Signature of Parent/Guardian:

Date:

Photography and Media Consent Do you consent to being photographed or filmed while participating in activities at Wellington Health and Fitness Club? These images may be used for promotional purposes.
Yes
No

Data Protection

I consent to Wellington Health and Fitness Club storing my personal information for the purpose of managing climbing activities and ensuring my safety. I understand that my information will be stored securely and will not be shared with third parties without my consent.

Signature:

Date:

Declaration

By signing below, I confirm that I have read, understood, and agree to the terms outlined in this waiver form. I acknowledge the risks associated with indoor rock climbing and agree to participate voluntarily.

Signature:

Date:

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