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Aesthetic Climbing Gym Liability Release Form

The following information will be used to complete a document that you will read and then sign. Please complete the following form to create the document. You can preview the document you will be signing

Participant Name

First Name *

Middle Name

Last Name *

Participant Date Of Birth *

Participant Address

Address *

City *

State *

Zip/Postal *

Can we email you great deals? *

Yes, please do!

No, only contact me regarding billing issues!

Emergency Contact

Emergency Contact First & Last Name *

Emergency Phone *

Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.

Parent or Legal Guardian

First & Last Name *

Parent or Legal Guardian Phone *

Gender *

Female

Male

Other

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.