boulder morty's
indoor rock climbing gym
Parental Waiver — Release of Liability
I understand that my child will be instructed to climb in boulder
morty's indoor rock climbing gym. It may be different from other gyms,
and it is quite different than outdoor climbing. I further understand
that the mission of boulder morty's staff is to make this experience
a safe and enjoyable one for all climbers. With that in mind, I hereby
acknowledge and agree:
1. That rock climbing is inherently risky and those risks include
but are not limited to:
- Falls from or contact with walls and equipment
- Inattention of belayers
- Poor decision-making by or the actions of other climbers
- Misuse or failure of equipment
- Holds which may have become loose or damaged
- Other unforeseen circumstances beyond the control of management;
2. To knowingly and intentionally waive and release and agree
to hold harmless and indemnify boulder morty's, its successors, assigns,
officers, employees, wall designers and builders, hold manufacturers,
lessors and agents from all liability for any such damage, injury or
death which my result;
3. That my child is in good health and has no physical limitations,
which would affect the safe use of the facilities.
FOR INSURANCE PURPOSES, ALL OF THE FOLLOWING INFORMATION MUST BE
PROVIDED
Child's Name:_______________________________________Date of Birth:______/______/________
Parent(s) Name: ____________________________________________________________________
Street Address:________________________________________________________________________
City / State / Zip Code:__________________________________________________________________
Telephone Number:___________________________________________________________________
Emergency Contact Information:
Name:_________________________________________Phone Number(_______)_______________
Date:__________/___________/_____________
Signature of Parent or Legal Guardian:______________________________________________________
OR IN ABSENCE OF PARENT or LEGAL GUARDIAN
Signature of Group or Party Leader:_______________________________________________________
boulder morty's indoor rock climbing gym
25
otterson street • nashua • new hampshire 03060
Phone 603-886-6789 • Fax 603-882-0003 |
