REGISTRATION FORM

SUPERVISED CLIMBERS UNDER THE AGE OF 18 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.


Conditions of Use


• Report to reception on each visit before climbing.
• You must exercise care, common sense and self preservation at all times
• Report any problem with the walls, equipment or other climbers behaviour to a member of staff immediately. This is particularly important with broken or spinning holds.
• Be aware of the other climbers around you and how your actions will affect them
• Never stand directly underneath someone who is climbing.
• If you have children, you must keep them under control and supervise them directly at all times. Be close enough to affect or control the child’s behaviour at all times.
• Please make yourself aware of the location of the fire exists in the building and fire assembly
points.
As a user of this climbing wall, you must be aware of and accept the following:
• Volumes on the walls are designed to enhance the quality of climbing but you must be aware of
and accept that when climbing above them there is an additional risk of falling onto them.
• Climbing beyond your capabilities on any wall is likely to result in a fall. Any fall may result in injuries despite the safety systems in place. You must make your own assessment of the risks whenever you climb.
• Participants must understand that climbing while pregnant can increase the risk posed to mother and unborn child.
• Participants must be aware and accept that climbing holds can spin or break.
• You must do everything reasonable and practical to avoid endangering yourself or others.
• You have to be aware of and adhere to the safety rules of the centre at all times.
• Stand back from the climbing walls unless you are spotting a climber.
• Please empty your pockets and removes all jewellery before climbing.
• Whenever possible, down climb, or if it not possible, use a controlled/ planned jump.
• It is your responsibility to ensure that you can climb down or land safely : don’t climb into a situation that you can not safely get out of.
• Never climb directly above or below another climber.
• Top out (climb over the top) in designated areas only, if you are unsure. Climb down.
• Remove anything from pockets that could hurt you when landing
• Always be aware of people climbing above and around you.
• Use the training area equipment at your own risk.
• If you are unsure how to safely use any item in the training area, please ask a member of staff.


THE SOFT MATTING DOES NOT REMOVE THE RISK OF INJURY. Injuries can still occur even after a controlled/planned jump but are more likely after an uncontrolled fall. You should always do your utmost to avoid the risk of uncontrolled falls. This includes paying attention to how you will land and always assessing the risk of each climb that you undertake.


Our duty of care : The conditions of use of the climbing centre are not intended to limit your enjoyment of the facilities, they are part of the duty of care that we as operators, owe to you , the customer, by law. As such, they are not negotiable and if you are not prepared to abide by them then the staff may ask you to leave.


Your duty of care : You have a duty of care to act responsibly towards the other users of the centre, follow good practice and abide by the conditions of use of the centre. Statements of ‘Good Practice’ are posted around the centre. These describe the accepted methods of use of equipment and climbing areas.


Unsupervised climbing


Before you can use the bouldering walls without supervision, you must be aware of the safe usage of bouldering and know how to use the bouldering walls safely. You are required to register to say that you know how to boulder and that you are prepared to abide by the rules and that you understand the risks involved in your participation. Anyone who is not competent to climb unsupervised must be supervised by a competent person.


Supervised Climbing


An adult who has registered at the centre, proved competency, may supervise up to two novice climbers, as long as they are prepared to take full responsibility for the safety of those people. Groups of three or more novices must only be supervised by an instructor holding the relevant qualification. All children in the centre must be supervised by an adult unless they have been assessed by the management and registered for unsupervised climbing.

I have read and agree to the CONDITIONS OF USE 

Participant Details

First Name
 
Surname
 
Date of Birth
 
Email address
 

Participant Address

Line 1
 
Line 2
Line 3
Line 4
City
 
County
 
Post Code
 

Participant Telephone

Phone number
 

Parent or Legal Guardian

Parent or legal guardian must sign for any participating minor (those under 18 years of age) and agree that they and the mi-nor are subject to all the terms of this document as set forth in this document.
Full Name
 
Phone number
 

Emergency contact if not parent or guardian above

Full Name
 
Phone number
 

Conditions of Registration

This acknowledgement of Risk Form is for unsupervised climbing at BoulderWorld Belfast. If you are unsure of any aspect of the form you Should Not fill this in online. Please come to BoulderWorld and fill it in where a staff member can answer any questions or clarify any points that may be unclear. If you have any impairments that can affect your filling in of the form or climbing, please fill in the form within the centre with staff support. Please answer Yes / No to the following questions.

Only climbers who give satisfactory answers to the questions will be registered and allowed to climb in the centre. Please read all the questions carefully. If you have not answered a question correctly you will be asked to complete the form again :

Are you legally responsible for the above named person?
 
Have you and your child read and understood this Acknowledgement of Risk and Conditions of Use for climbing and bouldering?
 
Do you and your child understand that failure to exercise due care could result in injury or death?
 
Do you and your child understand that the boulder matting does not remove the risk of injury?
 
Do you understand that you must be supervised at all times whilst in the centre by a registered ‘UNSUPERVISED’ member over the age of 18?
 
Does your child have any medical problems you feel we should know about that could flare up or become exasperated during climbing?
Please include any relevant details about medications / allergies / preferences we should know about.
Does your son / daughter have any medical problems you feel we should know about? (asthma, disability, diabetes, epilepsy)
Please include details about any medicines being taken and any allergies e.g. penicillin, plasters etc.


Customer Agreement

Please read each of the following statements and tick each box to say that you understand.
By ticking this box I am confirming that I understand each of the above statements and the dangers involved in climbing and I agree for my child to abide by the terms and conditions provided by Boulder world Belfast.  
By ticking this box I confirm that the above information is correct and if any information changes, I will notify Boulder Belfast.  
Can we use your email to send you news and updates needed for you BoulderWorld Account ?
 
Electronic Signature Consent 

Online Form to be completed after reading the above

I CERTIFY TO THE BEST OF MY KNOWLEDGE, I DO NOT SUFFER FROM A MEDICAL CONDITION THAT MIGHT HAVE THE EFFECT OF MAKING IT MORE LIKELY THAT I BE INVOLVED IN AN ACCIDENT THAT COULD RESULT IN INJURY TO MYSELF OR OTHERS. I ALSO CONFIRM THAT THE ABOVE INFORMATION IS CORRECT AND IF ANY INFORMATION CHANGES I WILL NOTIFY THE CENTRE. I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTRIE DOCUMENT. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS.

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