Climb So iLL, Inc. Acknowledgement and Assumption of Risks & Release and Indemnity Agreement

The following information will be used to complete an Acknowledgment and Assumption of Risks & Release And Indemnity Agreement that you will read and then sign. Please complete the following form to create the Agreement. You can preview the Agreement you will be signing. If the participant is under the age of 13, you consent to our collection of personal information as submitted on the document. For example, we collect birth dates to validate the ages of the participant and we collect other information from a parent for the purpose of sending information related to our products and services. We do not collect any other personally identifiable information from children under the age of 13 during our registration process. Unless we indicate otherwise or obtain your consent, personally identifiable information collected from children under the age of 13 will be used solely by Climb So iLL, Inc. or its agents in connection with our products and services and will not be sold or otherwise transferred to third parties unless required by law.

This is the person participating in any 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 *
Email Address (if Participant is under the age of 18, enter Parent's email address) *

Participant Gender *

Participant Address

Address *

City *

State *

Zip/Postal *

Phone Numbers *

Primary Phone

Work Phone
We pinkie swear we'll only send you really great offers and invitations to climbing events! Your email address is sacred to us. We'll NEVER share it.
Can we email you great deals? *
Yes, please do!    
No, only contact me regarding billing issues!    

Emergency Contact

Emergency Contact First & Last Name *

Emergency Phone *

Relationship *

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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