A.C.G. Participant Form For Adaptive Climbers/Volunteers -New York City
This is registration for Adaptive Climbing indoor climbing sessions in New York City. Other sessions and Special events can be found on the calendar at
**YOU CAN NOT SIGN UP FOR A CLIMBING SESSION LESS THAN 3 HOURS BEFORE START TIME.
Cost for participants are a $11 dollars and $19 for guests. This is a 501c3 tax deductible donation to the Brooklyn Boulders Foundation keeping climbing accessible and affordable. Payment can be made at the front desk of the facility.
Participants and volunteers MUST wear masks for indoor and outdoor activities hosted by Adaptive Climbing Group. Exception accepted to outdoor heavy breathing exercises where participants and volunteers are more than 6ft apart. This is with the understanding that this is if breathing with a mask becomes difficult. All attendees are responsible for providing their own masks and other forms of protection.
If a participant requires direct physical assistance to take part in the activity, they are responsible for bringing along a P.A.(personal assistant) or COVID friendly family to assist them.
All Adaptive Climbing Group in person activities are at a maximum of 10 people, that includes participants, volunteers, and family members within the vicinity of the program-led activity.
All participants and volunteers will have their temperature taken, be screened for recent symptoms and high-risk exposures during the previous 2 weeks before the event. If any of these are present, the person will not be allowed to attend.
I, acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that Adaptive Climbing Group, a program of the Brooklyn Boulders Foundation has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.I further acknowledge that Adaptive Climbing Group can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, salon staff, and other salon clients and their families. I voluntarily seek services provided by Adaptive Climbing Group and acknowledge that I am increasing my risk of exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment. I attest that:* I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.* I have not traveled internationally within the last 14 days.* I have not traveled to a highly impacted area within the United States of America in the last 14 days.* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.I hereby release and agree to hold Adaptive Climbing Group harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of this program, or that may otherwise arise in any way in connection with any services received from Adaptive Climbing Group. I understand that this release discharges Adaptive Climbing Group from any liability or claim that I, my heirs, or any personal representatives may have against this organization with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any events attended of Adaptive Climbing Group. This liability waiver and release extends to the Adaptive Climbing Group together with Brooklyn Boulders Foundation, all partners, and all employees.
This serves as an electronic signature that I read and agree to the above statement.
Have you had any of the following new symptoms in the past 7 days?
Loss of Taste and Smell
None of The Above
Have you had or will you have any “high-risk” exposures in the 2 weeks leading up to the event?
If you answer yes, please consider the effect you have by coming into other and reconsider coming on a different day.
Close contact with a person infected with Covid-19
Attendance at an event with >10 people in close contact?
Work in a high-risk healthcare setting in contact with Covid-19 patients?
None of the Above
Is this your first time participating in an Adaptive Climbing Group weekly session?
I am an ADAPTIVE CLIMBER and have NEVER participated in an Adaptive Climbing Group session
I am an adaptive climber and HAVE participated in an ADAPTIVE CLIMBING GROUP session before
I am a VOLUNTEER and have NEVER participated in an Adaptive Climbing Group session
I am a VOLUNTEER and HAVE participated in an A.C.G. session before.
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This form was created inside of The Brooklyn Boulders Foundation.