Go Aloft! Rig-Climbing Experience Waiver

Go Aloft! Rig-Climbing Experience Waiver

Please complete this form to participate in the Go Aloft! rig-climbing experience at Bristol Dockyards. Read all safety rules, waiver terms, and acknowledgments before signing.
Each adult (18+) must fill out a separate form.
Date of Climb

DayMonthYear
Please select the date of your visit and climb to help us easily find your waiver on the day.
Who will be climbing:
Safety Rules and Important Information

• You will be provided with a full safety briefing by a fully trained instructor before your ascent up the rigging. You must follow the safety rules and advice at all times. Failure to do so may result in serious injury.

• This form must be signed by each participant/supervising adult for under 18 year olds before ascent up the rigging.

MINIMUM AGE: 10
MINIMUM HEIGHT: 1.4m (4’7’’)
MAXIMUM WEIGHT: 114KG (18 STONE)

The information you provide below will only be used for the purposes of this activity. It will not be used for any marketing purposes and will not be shared with any third party.
Adult Participant's Full Name

First NameLast Name
Adult Participant Medical Information
Please state any medical conditions, illnesses or allergic reactions that you have (eg asthma, heart conditions, pregnancy, back problems):
Adult Participant Medication Information
Please state any medication you are currently using to control these conditions (eg. inhaler, beta-blockers, adrenalin):
Child Participant's Full Name

First NameLast Name
Child Participant's Date of Birth

DayMonthYear
Date
Child Participant Medical Information
Please state any medical conditions, illnesses or allergic reactions that the child has (e.g. asthma, heart conditions, back problems).
Child Participant Medication Information
Please state any medication you are currently using to control these conditions (eg. inhaler, beta-blockers, adrenalin):
Second Child Participant's Full Name

First NameLast Name
Second Child Participant's Date of Birth

DayMonthYear
Date
Second Child Participant Medical Information
Please state any medical conditions, illnesses or allergic reactions that the child has (e.g. asthma, heart conditions, back problems).
Second Child Participant Medication Information
Please state any medication you are currently using to control these conditions (eg. inhaler, beta-blockers, adrenalin):
Emergency Contact Name
This must be a non-climbing adult. You can enter the name of a person visiting with you, but they have to remain on Top Deck for the duration of the climb.
Emergency Contact Number
Before Starting - Please ensure:

• Mobile phones and cameras are left on the Weather Deck
• Long hair is tied up, and all jewellery/piercings removed
• Headwear is removed or tied at the back of the head
• Suitable closed-toe footwear is worn (no open-toe shoes)
• Long trousers are recommended
Disclaimer

Participation in Go Aloft! is at the individual’s own risk. The SS Great Britain Trust accepts no responsibility and shall not be liable in any way whatsoever and accordingly no person shall have any claim against the Trust, its agents or employees for any loss, damage or injury arising from a person’s use of or participation in the Activity (except in the case of death or personal injury caused by the negligence of the Trust, its agents or employees).

Participation is at the discretion of SS Great Britain Trust. The Trust reserves the right to refuse or discontinue the participation of any person if, in the opinion of its authorised staff, that person is unfit or unable to participate safely or poses a risk to others.

You acknowledge that SS Great Britain Trust will not be liable for any direct or indirect loss of personal possessions and you waive all claims to SS Great Britain Trust in this respect.

If you do not follow advice from our instructors, you may be asked to leave with no refund.
Acknowledgments (Please read and confirm):

1. I am either the parent or guardian of such children and as such am authorised to sign this form on their behalf and consent to their participation in the activity (if applicable).

2. The activity requires a moderate level of fitness. There is a risk of injury when undertaking the activity and individuals participate at their own risk.

3. As far as I am aware, neither I nor the children named above have any medical condition that might be exacerbated by participation in the activity or that may result in injury to any person.

4. I agree to ensure that I and such children follow all safety instructions and that I am responsible for my own safety, and the safety and supervision of such children (if applicable).

5. In the event of any injury sustained as a result of participation in the activity, I consent (for me and such children) to emergency medical treatment being administered if required.

6. I agree I will not undertake the activity whilst under the influence of drugs or alcohol.
Photography Consent: Please select one option.
By signing below, you confirm that you have read, understood, and accept the information above.
Signee Full Name

First NameLast Name
Signee Signature
Instructor approved?
Should be Empty:

Go Aloft! Rig-Climbing Experience Waiver

Safety Rules and Important Information

Before Starting - Please ensure:

Disclaimer

Acknowledgments (Please read and confirm):