REGISTRATION FORM

SUPERVISED CLIMBERS UNDER THE AGE OF 18 at Boulderworld Ltd


BMC PARTICIPATION STATEMENT ‘ THE BRITISH MOUNTAINEERING COUNCIL RECOGNISED THAT CLIMBING AND MOUNTAINEERING ARE ACTIVITIES WITH A DANGER TO PERSONAL INJURY OR DEATH. PARTICIPANTS IN THESE ACTIVITIES SHOULD BE AWARE OF AND ACCEPT THESE RISKS AND BE RE-SPONSIBLE FOR THEIR OWN ACTIONS AND INVOLVEMENT’

The following information will be used to complete a document that you will read and then sign. Please complete the flowing form to create the document. You can preview the document you will be signing.

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

Please answer the following questions YES or NO in the box provided. Only climbers who give satisfactory answers to the questions will be registered and allowed to climb unsupervised. Please read all the questions carefully. If you have not answered a question correct you will be asked to complete the form again.

Do you and your child understand the matting under the walls does not guarantee your safety?
 
Do you and your child understand that failure to exercise due care could result in injury or death?
 
Do you and our child agree to abide by the RULES of the climbing centre?
 
Do you understand that your child must be supervised at all times whilst in the centre by a registered member over the age of 18 that is signed off to climb unsupervised?
 
Do you and your child have any questions about climbing under supervision at the centre?
 
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 ?
 
I have read and agree to the CONDITIONS OF USE. 
required fields