ADULT REGISTRATION FORM

Unsupervised Climbing at CITY BLOC

The British Mountaineering Council recognises that climbing and mountaineering are activities with a danger of personal injury or death. Participants in these activities should be aware of and accept these risks and be responsible for their own actions and involvement.


Personal Details

Title
First Name
 
Last Name
 
Gender
Date of birth
 
Email
 
Centre
 
Occupation
How did you hear about City Bloc? :
 

Address

Line1
 
Line2
Line3
Line4
City
 
County
Postcode
 

Telephone

Evening Tel. No.
Daytime Tel. No.
required fields

Conditions of Registration

Please read the Conditions Of Use And Rules Of the climbing centre, and answer the following questions. Only climbers who give satisfactory answers to the questions will be allowed to climb unsupervised.

Are you over 18 years of age?
Do you understand the Conditions of Use and Rules of the centre?
* Can you use a bouldering wall safely?
* Can you descend safely in accordance with the rules of this centre?
Are you an experienced climber or have watched the induction video?
Do you require instruction in any of the above techniques (marked *)?
Do you understand that failure to exercise care may result in injury?
Do you have any questions regarding The Conditions of Use or Rules?
Do you agree to abide by the Rules of the climbing centre?
How long have you climbed / bouldered?
How often do you climb / boulder? :

Declaration of fitness

I certify that to the best of my knowledge, I do not suffer from a medical condition which might have the effect of making it more likely that I be involved in an accident which could result in injury to myself or others.

Declaration of fact

I also confirm that the above information is correct and if any information changes I will notify the centre

Electronic Signature Consent 
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.
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I have read and agree to the Terms of Use.