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Bouldering wall online novice supervision form

 
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Participation statement

“All climbing and bouldering activities have a risk of serious injury or death. Participants must be aware of and accept that even if they follow all good practice there may still be the risk of accident and injury. It is the responsibility of the participant to adhere to the conditions of use.”

It is important that you understand this document. There is inherent risk involved with climbing centres and associated activities. By signing this form, you are stating you understand that these risks cannot be completely removed. If you do not understand any of the terminology or content, ask a member of staff to clarify.

Form

Bouldering wall online novice supervision form

  • Adult novice supervision
  • To be completed by a registered adult in bouldering 18 years+ Parents/Guardians/Adult Novices to read the ‘Acknowledgement of Risk'
  • Adult boulderer information
  • Supervision information
  • Children aged 5 years to 8 years Children must always be supervised by a ‘non climbing’ registered adult boulderer 18 years+ Completion of the Parent/Guardian declaration on this form.
  • Children aged 8 years to 17 years Must always be supervised by a registered adult bouldering wall member 18 years + Completion of the parent/guardian declaration on the reverse of this form.
  • Adult Novice Guest/s 18 years + Non inducted adults must always be supervised by a registered adult boulderer 18 years + Completion of the adult guest declaration on the reverse of this form.
  • Novice climbers are the responsibility of the supervisor and the supervisor must remain with their novice/s when in the centre. The supervisor has a duty to inform the novice of relevant risks and help them manage these risks. Best practice notices are displayed within the climbing wall. The maximum novice supervision is 2 novice guests only
  • Novice guest 1 name
  • Novice guest 2 name
  • Parent/guadrian declaration
  • I certify that to the best of my knowledge, my child does not suffer from a medical condition that might have the effect of making it more likely that they will be involved in an accident that could result in injury to themselves or others. I also confirm that the above information is correct and if any information changes I will notify the centre.
  • Adult/Novice guest/s declaration
  • I certify that to the best of my knowledge, I do not suffer from a medical condition that might have the effect of making it more likely that I will be involved in an accident that could result in injury to myself or others. I also confirm that the above information is correct and if any information changes I will notify the centre.
  • I have had sufficient opportunity to read the entire ‘acknowledgement of risk’ below, understand it, and agree to be bound by its terms.
  • Parent/Guardian name
  • Adult novice 1
  • Adult novice 2
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The personal information on this form will be retained to demonstrate that consent was sought for the child detailed above to take part in the specified activity(s).  We will use the information provided to contact you in an emergency and ensure that staff delivering the sessions are aware of any medical or special support needs. We will not share your child’s personal information with any third parties. Blackpool Council is the Data Controller for the personal information you have provided in this form. The council’s data protection officer can be contacted at DPA@blackpool.gov.uk

For further information about how Blackpool Council uses your personal information, including your rights as a Data Subject.

Acknowledgement of risk

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  • General safety

  • Bouldering

  • Unsupervised climbing

  • Supervised climbing

  • Our duty of care

  • Your duty of care

  • Children

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Rules

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  • General safety

  • Bouldering and traversing