ONSIGHT CLIMBING GYM

REGISTRATION & WAIVER FORM

This waiver form must be completed before the commencement of activity.

Onsight Climbing Gym reserve the right to deny admission to anyone whom we determine unable to meet the physical, mental, or safety demands of the course without risk or harm to

his/her self or others.

NRIC/Passport No. Name of Participant Date of Birth Age Gender

M F

Address Email

Contact Number

Name of Contact Person Relationship to Participant Emergency Contact Number

Signature Date

For applicants under the age of 18 years old

I, as parent, guardian or responsible party of the above named minor child under the age of 18 years, hereby acknowledge reading, understanding and agreeing to the terms and conditions of this agreement.

Name and NRIC of GUARDIAN Signature Date

Do you have any conditions that may adversely affect your capacity to participate in this

activity??

1. Chest Pain,High Blood Pressure, Heart Problems, e.g. Heart

Murmur,Extra Heartbeat or Other Heart Abnormality. YES / NO

2. Asthma, Bronchitis, Tuberculosis, Sinusitis, Other Lung Problems YES / NO

3. Fits, Epilepsy, Fainting Attacks, Migraine, Severe Head Injury YES / NO

4. Any Present Back or Spinal Injuries YES / NO

5. Any Present Dislocations / Sprains YES / NO

6. Any Disabilities or any other Medical Information to note YES / NO

If YES: Blood Type:

UNDERTAKING BY APPLICANT

I declare that all medical information provided above is true to the best of my knowledge and

I did not withhold any vital information. I am currently not suffering from any acute ailment or

diseases.

ACKNOWLEDGEMENT, WAIVER & RELEASE FROM LIABILITY AGREEMENT

THIS DOCUMENT IS A LEGALLY BINDING AGREEMENT. BYSIGNING THIS AGREEMENT YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTOOD AND ACCEPTED THE TERMS AND CONDITIONS STATED IN THIS AGREEMENT. YOU FURTHER ACKNOWLEDGE AND AGREE THAT YOU ARE WAIVING YOUR RIGHTS TO BRING ANY COURT ACTION TO RECOVER COMPENSATION OR OBTAIN ANY OTHER REMEDY FOR ANY INJURY TO YOUR SELF OR YOUR PROPERTY. ACKNOWLEDGEMENT: I acknowledge that there are significant elements of risk associated with the height activities (sport of rock climbing and via ferrata). I further acknowledge the nature and extent of the risks inherent in the height activities and the use of the facilities. I acknowledge that there are possible risks associated with the use of the facility, and that other unknown and unanticipated risks may result in injury, illness, or death. RELEASE, ASSUMPTION OF RISK AND RESPONSIBILITY: In consideration of, and in recognition of the inherent risks of the activity associated with the use of the facility, I, and/or on behalf of any minor children for which I am responsible for, agree, on behalf of myself, my/our heirs, representatives, successors, executors, administrators and assigns, to hereby release, waive, discharge and agree not to sue its officers, directors, shareholders, agents and employees, for any and all claims or demands, obligations and/or causes of action of any nature whatsoever which I may have against its officers, directors, shareholders, agents and employees, on account of any personal injury, property damage, death or accident of any kind, arising out of or in any way connected with use of the facility or equipment, whether my/our use is supervised or unsupervised and I/we agree to indemnify and hold harmless the persons or entities mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of my/our actions. I further certify, acknowledge and agree on behalf of myself and/or any minor children for which I am responsible, that: I am (we are) physically and mentally capable of participating in the activity and/or use the equipment. I/we assume responsibility for and voluntarily assume the risks for any personal injury, death and related expenses involved with this activity. I/we assume responsibility for damage to my/our personal property, and I/we assume the risks for accidents or injury caused by the negligence of my fellow climbers. IN WITNESS WHEREOF, I have signed this agreement on this day.

PARTICIPANT’S PARTICULARS

EMERGENCY CONTACT PERSON’S PARTICULARS

INDEMNITY MEDICAL DECLARATION

GUARDIAN’S CONSENT

ONSIGHT VENTURES PTE LTD 100 Guillemard Road, Singapore 399718 Tel/Fax : 65.6348.8272 www.onsight.com.sg