Albany's Indoor Rockgym - Risk Form (Page 1)

Albany's Indoor Rockgym
4C Vatrano Rd, Albany NY 12205
(518) 459 7625

Print last name: ________________________________  Date: ___________________
Participant's address: __________________________  Phone: __________________
                 City: __________________________  State: ____  Zip: _______

This document affects your legal rights. Read it carefully and sign/initial in all the appropriate spaces. This is a legally binding agreement.

There are significant elements of risk inherent in rock climbing and caving.

Acknowledgment of Risk:
I (print participant's name) _________________________ hereby acknowledge and agree that climbing, caving, ropes courses and experiential education have inherent risks, and that there are significant risks involved in all aspects of those activities whether indoor or outdoor. I further acknowledge and agree that those risks include but are not limited to:

  1. FALLS WHICH CAN RESULT IN SERIOUS INJURY OR DEATH.
  2. ALL MANNER OF INJURY RESULTING FROM HITTING PROJECTIONS, WHETHER PERMANENTLYOR TEMPORARILY IN PLACE, OR THE GROUND.
  3. INJURIES RESULTING FROM BEING HIT BY PEOPLE FALLING OR DROPPED ITEMS, SUCH AS, BUT NOT LIMITED TO ROPES, CLIMBING HOLDS, AND CLIMBING HARDWARE.
  4. CUTS, ABRASIONS AND OTHER WOUNDS RESULTING FROM SKIN CONTACT WITH GYM WALLS.
  5. FAILURE OF THE ROPES, SLINGS, HARNESSES, CLIMBING HARDWARE, HOLDS, ANCHOR POINTS, OR ANY PART OF THE GYM.
  6. ROPE ABRASION, ENTANGLEMENT AND OTHER INJURIES RESULTING FROM ACTIVITIES INSIDE THE GYM, BUT NOT LIMITED TO CLIMBING, CAVING, BELAYING, RAPPELLING, LOWERING ON ROPE, RESCUE SYSTEMS AND ANY OTHER ROPE TECHNIQUE.
  7. I FURTHER ACKNOWLEDGE THAT THE ABOVE LIST IS NOT INCLUSIVE OF ALL POSSIBLE RISKS ASSOCIATED WITH THE USE OF THE GYM.

I, the participant have fully read and understand the above. Initial: __________
If I am under (18) years of age, my parent or legal guardian has also read and signed this document.


Participant must sign name below:
_____________________________________________

Participant must clearly print name below:
_____________________________________________

Parent/Legal Guardian signature, if participant is under 18 years of age:
_____________________________________________

Parent/Legal Guardian clearly print name if participant is under 18 years of age:
_____________________________________________