Rockzilla
Waiver and Release
Each individual who will use the indoor and/or portable rock climbing equipment or inflatable play equiptment at
Rockzilla must read and sign this Waiver and Release. If the individual is under the age of 18 or is otherwise
legally unable to sign such a document, then a parent or legal guardian must read and sign this Waiver and
Release on behalf of that Participant. Every reference to “I” or my” shall include both the parent or legal
guardian and the participant on whose behalf the Waiver and Release is being completed.
I voluntarily agree to comply with all rules and conditions of Rockzilla. If I observe any unsafe condition, I will
bring it to the attention of the staff of Rockzilla.
I understand that there are inherent risks involved in using indoor rock climbing facilities, including all
equipment at Rockzilla. These risks include but are not limited to sprains, broken bones, joint or back injury,
and death.
I represent to the best of my knowledge that I am physically sound, and do not have any medical conditions that
would be aggravated by using indoor rock climbing equipment.
I assert that my participation is voluntary and that I knowingly assume all such risks. Therefore, I assume full
responsibility for using the indoor rock climbing equipment located at Rockzilla and I voluntarily and freely
choose to assume all such risks and dangers, including the risk of injury or death that may be associated with,
or result from, using the indoor rock climbing equipment, even if caused by the negligence of Rockzilla or its
staff or other guests.
I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant
not to sue Rockzilla, LLC and/or Rockzilla, LLC d/b/a Rockzilla and any of their affiliates, officers, members,
agents, employees, other guests or sponsoring agencies from liability from any and all claims resulting in
personal injury, accidents, illnesses, death, or property loss.
I give my permission to Rockzilla and its staff to obtain on my behalf any emergency medical treatment. In case
of sickness, accident, or injury, Rockzilla and its staff has my express permission to secure, at my expense,
such medical treatment as is deemed necessary in the sole discretion of Rockzilla and its staff.
By my signature below, I acknowledge that I have read and agree to all statements contained in this document.
This document will be kept on file and for the period stated below it releases all names for the given date
through and including the dates signed below.
PRINT Name of Participant(s): _______________________________________________________
Date of Birth: ___________________________________________________________________
Print Parent/legal guardian name (if applicable): _____________________________________
Parent’s or Participant’s signature: ______________________________________________
Today’s date: __________________________________through December 31, 2011.
Emergency Contact & Phone Number: __________________________________________