Participant Agreement and Release of Liability


The following information will be used to complete a document that you will read and then sign. Please complete the following form to create the document. You can preview the document you will be signing.





We pinkie swear we'll only send you really great offers and invitations to climbing events! Your email address is sacred to us. We will NEVER EVER share email address with any one else. We promise.
Will you please allow us to Email you incredible discounts and event specials? *
Yes, I love a good deal :)    
No, I like to pay full price :(    

Email Address *

Thank you very much! This information helps us to reach out to new climbers and continue to help grow the amazing sport of rock climbing.
How did you hear about Adrenaline Rock Climbing? *
B-day Party    
Family Member    
Friend    
Internet Search    
Scouts    
Group Event    
Magazine    
Print Ad    
Facebook    
Aerial Silks    
Summer Camp    
Other     

This is the person participating in the activities. If the participant is a minor, the form must be signed by a parent or legal guardian.
Participant Name

First Name *

Middle Name *

Last Name *
Date of birth of the participant, not the person signing the waiver.
Participant Date Of Birth *
We will use this to verify the identity of the person signing this waiver contract and that the person is at least 18 years old and/or the Parent or Legal Gaurdian if participant is a minor. *A physical check will be made of the driver's license before entry to the gym will be permitted. Minors must bring a copy of the signer's license to the facility or they will not be allowed to enter.
Please enter your complete Driver's License Number. (If the participant is under the age of 18, please provide the driver's license number of the Parent and/or Legal Guardian. A paper copy of the Parent and/or Legal Gaurdian license must accompany the minor to the gym for verification of signer.) *

Participant Address

Address *


City *

State *

Zip/Postal *

Phone Number *

Cell Phone
Emergency Contact

Emergency Contact First & Last Name *

Emergency Phone *

Electronic Signature Consent  *
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

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