Climbing Wall/Bungee/Inflatable Waiver
Sign in to Google to save your progress. Learn more
Climbers Name *
Climbing/Jumping is only allowed when 4C climbing wall/Bungee/Inflatables are open and staff is on duty. All climbers/jumpers will comply with the judgment and decisions of the staff on duty. All climbers/jumpers must have on file a signed waiver of liability Only climbing approved by 4 Corners Staff will be allowed on the wall/bungee/inflatables. Everyone must check in at the front counter before entering the climbing wall area.  No hard-soled footwear, cowboy boots or bare feet will be allowed on the climbing wall/bungee/inflatables. Rock climbing shoes or athletic shoes are recommended. Harnesses must be removed after climbing/jumping. Climbers/jumpers will not be allowed to leave the climbing wall/bungee area with a harness on. Use of the auto belay system requires successful completion of climbing test by 4 Corners Staff. After which auto belay climbing/jumping rules will apply to this individual. *
Required
Climbers Age *
Climbers Birthday (MM/DD/YEAR) *
MM
/
DD
/
YYYY
I have read and understand the above items and by signing this form I indicate that I agree to follow the 4C Rockwall/Bungee/Inflatable terms and conditions. I understand and acknowledge that the activity that I am about to voluntarily engage in as a participant bears certain known risks and unanticipated risks which could result in injury, death, illness or disease, physical or mental damage to myself, to my property or to spectators or other third parties. I agree to hold harmless and to indemnify 4 Corners Church, its employees, or volunteers. *
Name of Parent (This will be your Signature) *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Four Corners Community Church.

Does this form look suspicious? Report

Google Forms