Adult Registration Form at Boulderworld Ltd

Participation Statement

All climbing and bouldering activities have a risk of serious injury or death. Participant must be aware of and accept that even if they follow good practice there may still be the risk of accident and injury. It is the responsibility of the participant to adhere to the conditions of use. It is important you understand this document. There is inherent risk involved with climbing centres and associated activities. By signing this form you are stating you understand that these risks cannot be completely removed. If you do not understand any of the terminology or content, ask a member of staff to clarify.

Personal Information

First Name
First name should be alphanumeric, can contain ,'_@.- and at most 100 characters long.
Surname should be alphanumeric, can contain ,'_@.- and at most 100 characters long.
Date of Birth
Email address
First Line of Address
Address line1 should be alphanumeric, can contain ,'_@.- and at most 255 characters long.
Username should be alphanumeric, can contain @_.-, without space and at most 30 characters long.
Password should be alphanumeric, can contain _@.- and at most 15 characters long.
Confirm Password
Emergency Contact Name
Emergency Contact Number
Phone should be alphanumeric, can contain _@.+- and at most 15 characters long.

Customer Agreement

Please read each of the following statements and tick each box to say that you understand.

Matting does not guarantee your safety and down climbing is best practice when bouldering. Climbers should not climb, walk or stand under other climbers. Climbers should be aware of other climbers and observe good practice at all times. You are responsible for any U18 or novice climber within your care. Climbing holds may move, break or spoon and should be reported to a member of staff.
Do you suffer from any medical condition which makes it more likely you could be involved in an accident and cause harm to themselves or others? If yes please inform a member of staff on arrival.
Electronic Signature Consent 
By checking here and to the statements above, you are consenting to the use of the electronic signature in lieu of an original signature on paper. By checking here you are wavering that right.

Your agreement to use an electronic signature with us for any documents will continue until you notify us in writing that you no longer wish to use an electronic signature.
I confirm that I understand the above statements and the dangers involved in bouldering and agree to abide by the terms and conditions provided by BoulderWorld Belfast. 
I confirm that the information I have provided in this registration is correct and if any information changes I will notify Boulderworld. 
I confirm I have watched and understood the BoulderWorld Induction Video  
We would like to email you about our latest promotions, events and membership offers. We will never share any of your details with any third parties.
I have read and agree to the Conditions of Use.