Raleigh Rockyard, Inc.

Liability Waiver (Please complete both pages)

PLEASE PRINT LEGIBLY:

Name ____________________________________

Address __________________________________

City _________________________ State _____ Zip _________

Phone (____) _______________ Date of Birth ____________

Emergency Contact ________________________________________

How did you find out about the Raleigh Rockyard, Inc. (please be specific) ______________________________________________________

 

Raleigh Rockyard, Inc. Rules:
No smoking in the gym.
Parental supervision of minors under age of 14 required.
Everyone (over age 18) must read & sign a waiver (you may add your family members to one waiver). Parent / guardian must sign for all climbers under age 18
No barefoot climbing.
Spotters recommended when bouldering. Do not remove mats from bouldering areas.
Belay with approved belay devices only. No gri-gris, Muenter Hitches, or hip belays.
Harness with belayed top rope required 4ft. or higher off ground. No protection-free climbing.
Belayers must be RRY certified.

Tie in with figure-eight retrace/follow-through or with figure-eight on bight and carabiner (under 100 lbs.).
Before climbing, check & recheck your harness & tie-in knot.
Before belaying, check that your carabiner is locked and not side loaded.
Belayers must clip into a floor anchor.
Check your partner's harness, knot and carabiner.
No food or beverages allowed in climbing area. Water is ok.
No one under the influence of alcohol or drugs allowed on premises.
No climbing directly below or above other climbers.
Do not climb on top of the wall structures. Do not throw items of any kind
No running or racing in or about the gym.

No Swinging on ropes.

No spittin or cussin.

Be safe. Be cool. Have fun!!!
Thanks for your cooperation. Raleigh Rockyard, Inc

 

 

 

 

I HEREBY UNDERSTAND, ACKNOWLEDGE, AND AGREE AS FOLLOWS: CLIMBING, events and activities related to, associated with, or connected with climbing CAN ALSO EXPOSE ME TO HAZARDS AND RISKS, BOTH NATURAL AND ARTIFICIAL and IS AN INHERENTLY HAZARDOUS AND DANGEROUS ACTIVITY THAT CAN RESULT IN HARM, LOSS, DAMAGE, PERSONAL INJURIES, OR DEATH. My use of the Raleigh Rockyard, Inc. (hereinafter, the "GYM"), its facilities, equipment, or apparatus is entirely voluntarily and with a complete and full understanding that any and all such usage, including, but not limited to climbing, is entirely voluntarily and with a complete and full understanding that any and all such usage involves hazards and dangers that can result in harm, loss, damage, personal injuries, and death and that I assume ALL RISKS AND RESPONSIBILITY FOR ANY HARM, LOSS, DAMAGE, PERSONAL INJURY, OR DEATH RESULTING FROM, ARISING OUT OF, OR IN CONNECTION WITH ANY AND ALL SUCH USAGE. . I WILL OBEY AND COMPLY WITH ALL RULES, REGULATIONS, OR INSTRUCTIONS 0F THE GYM OR ITS EMPLOYEES OR AGENTS, and that I have a responsibility to ask questions and clarify any rules, regulations, or instructions if I do not understand, fully comprehend, or have any doubts about any rule, regulation, or instruction. I have an obligation and responsibility to myself, as well as to other users of the GYM, its facilities, equipment, or apparatus, to conduct myself in a safe and reasonable manner, and that I will not use the GYM, its facilities equipment, or apparatus while under the influence of drugs or alcohol or while suffering from or experiencing any condition that might impair me. I am responsible for checking and maintaining the safety and good operating condition of any and all personal equipment, gear, or apparel that I may utilize while using the GYM, its facilities, equipment, or apparatus regardless of where or from whom I may have obtained such personal equipment, gear, or apparel; that any equipment, gear, or apparel that I may receive, rent or borrow from the GYM, or any GYM facilities, equipment, gear, or apparel that I may use, I USE AT MY OWN RISK AND IT IS EXPRESSLY UNDERSTOOD, ACKNOWLEDGED, AND AGREED THAT THE GYM, ITS OFFICERS, DIRECTORS, EMPLOYEES, AND/OR AGENTS SHALL NOT BE LIABLE FOR ANY HARM, LOSS, DAMAGE, PERSONAL INJURY, OR DEATH RESULTING FROM THE USE OF SUCH FACILITIES, EQUIPMENT, GEAR, OR APPAREL. That in consideration of being permitted to use the GYM, its facilities, equipment, and/or apparatus, for myself and on behalf of my heirs, personal representatives and assigns, I HEREBY WAIVE, RELEASE, AND DISCHARGE FOREVER, Raleigh Rockyard, Inc., THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AND AGENTS, FROM ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, OR CAUSES OF ACTION WHATSOEVER FOR ANY HARM, LOSS, DAMAGE, PERSONAL INJURIES OR DEATH, DUE TO NEGLIGENCE OR ANY OTHER CAUSE, RESULTING FROM, ARISING OUT OF, OR IN CONNECTION WITH MY USE OF THE GYM, ITS FACILITIES, EQUIPMENT, OR APPARATUS.

** HELMET : I understand that climbing is dangerous, and I am assuming this risk voluntarily. I am aware of the gym's safety policy requiring the use of a protective helmet, and understand that this protection could but may not prevent permanent brain injury or death in the event of an accident. If I decline to use this safety equipment, it is at my own risk, and against the advice of the RaleighRockyard, Inc. I understand that it is my sole responsibility and decision to do so.

I REPRESENT AND ACKNOWLEDGE THAT I HAVE FULLY READ THIS ACKNOWLEDGEMENT OF RISK, WAIVER OF LIABILITY, AND RELEASE OF LIABILITY AND FULLY UNDERSTAND EACH AND EVERY PROVISION AND THAT I AM VOLUNTARILY EXECUTING THIS AGREEMENT.

Name (Please Print): _________________________________________________

Signature: __________________________________________________________

**** If under 18, signature of a parent or legal guardian; indicate name and relationship:

___________________________________________________________________

Date Received: ____/____/____ By:________________ Belay Check Passed Date____/_____/____