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First Name (required)
Last Name (required)
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Date of Birth (required)
Emergency Contact Name
Emergency Contact Phone Number
Do you have any medications or conditions relevant to safe climbing? NoYes
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Conditions relevant to safe climbing
Medications relevant to safe climbing
Climbing involves real risk. Falls, collisions, holds, walls, mats, equipment, overexertion and other conditions can cause serious injury, permanent disability or death. ACG manages risks but cannot eliminate all of them.
By signing, I confirm that I understand and voluntarily accept the inherent risks of climbing; will follow staff instructions, signs, closures and facility rules; will keep clear of fall zones; will climb at or below my height until I can descend or fall in a controlled way; will not climb while impaired or unsafe; and will take reasonable care for myself and others.
If the participant is under 18, a parent or legal guardian must complete and sign this form.
Signature confirming agreement with ACG’s Terms and Conditions
ACG collects this information for entry, safety, emergency response, recordkeeping and related lawful purposes. It may be used, retained and disclosed as described in ACG’s Privacy terms.
