Climbing Gym Wall Use Permission Form
Please complete this form to provide your details and acknowledge the risks and rules associated with using our climbing wall.
Participant Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any medical conditions or allergies we should be aware of?
*
Please indicate your climbing experience level
*
Beginner
Intermediate
Advanced
Other
Have you read and understood the climbing wall rules and safety guidelines?
*
Yes, I have read and understood the rules and guidelines.
No, I have not read them yet.
Participant Signature (or parent/guardian if under 18)
*
Submit Permission Form
Submit Permission Form
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