Third Space Canary Wharf climbing wall registration form

• Audit Title

• Client / Site

Participation Statement The British Mountaineering Council recognises that climbing and mountaineering are activities with a danger of personal injury or death. Participants in these activities should be aware of and accept these risks and be responsible for their own actions and involvement.

• First name

• Surname

Condition of registration Once you have read the conditions of use and rules of the climbing wall, you must answer the following questions by answering Yes or No and then sign the declaration at the bottom of the form. Only climbers that give satisfactory answers to the questions will be registered and allowed to climb. This form applies only to Third Space Canary Wharf.

• Have you read and understood the Conditions of use and rules of the climbing wall facility?

  Yes

  No

• Do you have any questions regarding the application of the conditions of use or the rules?

  Yes

  No

• Do you understand that failure to exercise due care could result in injury to yourself or others?

  Yes

  No

• Do you agree to abide by the rules of the climbing wall facility?

  Yes

  No

• Can you put on a climbing harness correctly? (demonstrated to inductor)

  Yes

  No

• Can you climb safely using the auto belay system? (demonstrated to inductor)<br>

  Yes

  No

• Do you require any further instruction on anything relating to the safe use of the climbing facility?

  Yes

  No

Climbers declaration of fitness I certify that to the best of my knowledge that I do not suffer from any known medical condition that might have the effect of making it more likely that I could be involved in an accident that could result in serious injury to myself or others.

Climbers declaration of fact I confirm that the above information is correct and if any information should change then I will notify the club straight away.

• Climbers signature

  Sign

• Inductors signature

  Sign