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THE ROCK

I,_____________________ , age_____, knowingly and voluntarily enter into this Release and Indemnity Agreement. I know and understand the meaning and effect of this document.

I enter into this agreement for and in consideration of the privilege of participating in indoor and/or outdoor climbing activities, and/or purchasing and using equipment at THE ROCK. I acknowledge that I am at least eighteen years old or a parent or guardian of a person less than eighteen years of age, and that I desire to climb and/or use climbing equipment and do so voluntarily with the full understanding of the inherent risk of injury.

I understand that the activity of climbing involves numerous risks of injuries that are inherent in the activity. I understand and acknowledge that climbing and using climbing equipment involves moving through rough and steep terrain and that the risk of falling, being cut, bitten, and many other injuries are inherent to the sport. I understand that some hazards are foreseeable and some are not. I also understand the risk of injury. I assume any and all risk of injury, death and property damage.

Therefore, in consideration for the privilege of participating in the Outdoor Recreation program, the undersigned hereby voluntarily agrees to assume the risk associated with such a program and does hereby discharge the Government of the United States and all its officers, agents and employees, acting officially or otherwise, from and all claims, demands, actions or causes of action on account of the death or personal injury of the Undersigned or on account of the loss or destruction of personal property belonging to the Undersigned, which may occur as a result of the Undersigned’s participation in the aforementioned Outdoor Recreation program.

_______________________	_______________________
Signature	Date
_______________________	_______________________
Signature of parent or guardian of minor	Date
_______________________	_______________________
Signature of Outdoor Recreation Rep.	Date

PARTICIPANT INFORMATION

______________	______________	______________
Name	Rank/Grade	Social Sec. Number
_____________	_____________	_____________
Address	Home Phone	Birth Date
_____________	_____________
Organization	Duty Phone
______________	______________
Physical Ailments	Special Training
_______________
Climbing History
_______________	_______________	_______________
Orientation Class Date	Instructor	ODR

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