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Participation In Climbing At Zion Climbing Center, Inc.
I, _____________ choose to participate in the sport of indoor rock climbing at Zion Climbing
Center, Inc. knowing the inherent risks that come along with the sport of rock climbing.
I understand and am aware that indoor rock climbing at Zion Climbing Center, Inc. is a
potentially hazardous activity that Zion Climbing Center, Inc. has advised me on the dangers
that include, but are not limited to, broken bones, emotionally traumatic repercussions from
a possible fall, tendonitis, acrophobia attacks, heart attacks and possibly death.
I further understand that there are also other remote risks that may be associated with
climbing at Zion Climbing Center, Inc. despite the fact that a complete accounting of all the
remote risks have not been provided to me, it is still my desire to participate.
I understand I will be given the opportunity to ask questions and discuss any concerns
about rock climbing.
I further profess that I have participated and agree to the following:
I am climbing at my own risk and will not hold Zion Climbing Center, Inc. or its
agents, owners, or employees, and other persons or entities liable for any situation
that arise due to my negligence, misbehavior, or faulty equipment.
I further understand that Zion Climbing Center, Inc. reserves the right to deny or relinquish
rock climbing privileges for any person for any reason it sees fit. I understand that
horseplay, misbehavior, breaking of rules, foul language, and no-compliance with any Zion
Climbing Center, Inc staff recommendations could result in the termination of my climbing
privileges.
I also understand that FOUL LANGUAGE, FIGHTING, SMOKING, AND ALCOHOLIC
BEVERAGES ARE PROHIBITED on the premises.
I permit Zion Climbing Center, Inc. to use my image and likeness in digital and/or print
media and I understand I will receive no compensation for such use.
Please completely fill out the information below (print clearly):
First Name Last Name
Address
Zip Code
City/State
Cell Phone
E-mail Address
Emergency Contact Emergency Phone
Signature of Participant Date Witness or Parent/Guardian Date
(if under 18 years of age)
Office Use only: Just Climb Belay Bouldering Lead Climb Lead Belay W a i v e r E n t e r e d ?
Home Phone
Birthday
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