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Phoenix Rock Gym
Thrash & Dangle Enterprises, LLC.
1353 E University
Tempe, AZ 85281
480 921-8322
480 237-0095fax
We do not sell or give away customer information.
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Name
Address
City
State
Phone (
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Zip
Date of Birth ____/____/____
Emergency Contact
How did you find out about the Phoenix Rock Gym
Phoenix Rock Gym Rules
Everyone must read & sign a waiver.
Parental supervision of minors required.
Harness with belayed toprope required on canyon walls.
Belay with Grigris (belay safety device) only.
Tie in with figure-eight retrace/follow-through only.
Before climbing, check & recheck your harness & tie-in knot.
Before belaying, check that your carabiner is locked and not side loaded.
Belayers must clip into a floor anchor.
Check your partner's harness, knot and carabiner.
No food or beverages allowed in climbing area.
No one under the influence of alcohol or drugs allowed on premises.
No climbing directly below or above other climbers.
Do not climb on top of the wall structures.
No racing.
No spittin or cussin.
No smoking.
Be safe. Be cool. Have fun!!!
I have read and understand the above rules ______(Initial)
IMPORTANT: Turn over and complete side two. Eight spots to initial and print & sign your name!
Phoenix Rock Gym
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ACKNOWLEDGEMENT OF RISK, WAIVER OF LIABILITY, AND RELEASE OF LIABILITY
I HEREBY UNDERSTAND, ACKNOWLEDGE, AND AGREE AS FOLLOWS:
1. THAT CLIMBING IS AN INHERENTLY HAZARDOUS AND DANGEROUS ACTIVITY THAT CAN RESULT IN HARM,
LOSS, DAMAGE, PERSONAL INJURIES, OR DEATH. ______ (Initial)
2. That events and activities related to, associated with, or connected with climbing CAN ALSO EXPOSE ME TO HAZARDS AND
RISKS, BOTH NATURAL AND ARTIFICIAL, THAT MAY RESULT IN HARM, LOSS, DAMAGE, PERSONAL INJURIES, OR
DEATH. ______ (Initial)
3. That my use of the PHOENIX ROCK GYM (hereinafter, the "GYM"), its facilities, equipment, or apparatus is entirely voluntarily
and with a complete and full understanding that any and all such usage, including, but not limited to climbing, is entirely voluntarily
and with a complete and full understanding that any and all such usage involves hazards and dangers that can result in harm, loss,
damage, personal injuries, and death and that I assume ALL RISKS AND RESPONSIBILITY FOR ANY HARM, LOSS, DAMAGE,
PERSONAL INJURY, OR DEATH RESULTING FROM, ARISING OUT OF, OR IN CONNECTION WITH ANY AND ALL SUCH
USAGE. ______ (Initial)
4. THAT I WILL OBEY AND COMPLY WITH ALL RULES, REGULATIONS, OR INSTRUCTIONS 0F THE GYM OR ITS
EMPLOYEES OR AGENTS, and that I have a responsibility to ask questions and clarify any rules, regulations, or instructions if I do
not understand, fully comprehend, or have any doubts about any rule, regulation, or instruction. ______ (Initial)
5. That I have an obligation and responsibility to myself, as well as to other users of the GYM, its facilities, equipment, or apparatus,
to conduct myself in a safe and reasonable manner, and that I will not use the GYM, its facilities equipment, or apparatus while under
the influence of drugs or alcohol or while suffering from or experiencing any condition that might impair me. ______ (Initial)
6. That I am responsible for checking and maintaining the safety and good operating condition of any and all personal equipment,
gear, or apparel that I may utilize while using the GYM, its facilities, equipment, or apparatus regardless of where or from whom I
may have obtained such personal equipment, gear, or apparel; that any equipment, gear, or apparel that I may receive, rent or borrow
from the GYM, or any GYM facilities, equipment, gear, or apparel that I may use, I USE AT MY OWN RISK AND IT IS
EXPRESSLY UNDERSTOOD, ACKNOWLEDGED, AND AGREED THAT THE GYM, ITS OFFICERS, DIRECTORS,
EMPLOYEES, AND/OR AGENTS SHALL NOT BE LIABLE FOR ANY HARM, LOSS, DAMAGE, PERSONAL INJURY, OR
DEATH RESULTING FROM THE USE OF SUCH FACILITIES, EQUIPMENT, GEAR, OR APPAREL. ______ (Initial)
7. That in consideration of being permitted to use the GYM, its facilities, equipment, and/or apparatus, for myself and on behalf of my
heirs, personal representatives and assigns, I HEREBY WAIVE, RELEASE, AND DISCHARGE FOREVER, PHOENIX ROCK
GYM, THRASH AND DANGLE ENTERPRISES, LLC., THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AND
AGENTS, FROM ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, OR CAUSES OF ACTION WHATSOEVER FOR ANY
HARM, LOSS, DAMAGE, PERSONAL INJURIES OR DEATH, DUE TO NEGLIGENCE OR ANY OTHER CAUSE,
RESULTING FROM, ARISING OUT OF, OR IN CONNECTION WITH MY USE OF THE GYM, ITS FACILITIES, EQUIPMENT,
OR APPARATUS. ______ (Initial)
I REPRESENT AND ACKNOWLEDGE THAT I HAVE FULLY READ THIS ACKNOWLEDGEMENT OF RISK, WAIVER OF
LIABILITY, AND RELEASE OF LIABILITY AND FULLY UNDERSTAND EACH AND EVERY PROVISION AND THAT I AM
VOLUNTARILY EXECUTING THIS AGREEMENT. ______ (Initial)
Name (Please Print):_________________________________________________
Signature:__________________________________________________________
If under 18, signature of a parent or legal guardian; indicate name and relationship:
___________________________________________________________________
Date Received: ____/____/____