Climbing Membership Check In – Activate Waterford

Attendees

Please complete all required fields below and sign to complete form.

Name*

First

Last

Member Number

Name*

First

Last

Member Number

Phone*

Check-In Date*

I am using the bouldering rooms only*

Yes
No

I am using the bouldering and high wall*

Yes
No

I am Belay/ Auto Belay passed*

Yes
No

Further information on people at higher risk from Coronavirus can be accessed on the HSE website

Please take responsibility for your movements, your child’s movements or another person or child that you have with you and do not put others in danger. Please note when entering our premises that we are following all the latest NSAI, HAS and HSE guidelines to ensure all staff and customers are as safe as possible when undertaking activities here atACTIVATE during COVID-19 pandemic. Although we have adhered to all the advice given, we cannot ultimately guarantee that you will be entirely COVID-19 safe due to circumstances that may be beyond our control.

It is each individual’s responsibility to play their part.

Consent

I have understood the Conditions of Entry to the Premises and have explained same to the child/ren for whom I am responsible.*

I have understood the Conditions of Entry to the Premises and have explained same to the child/ren for whom I am responsible.

I agree that I and the child/ren for whom I am responsible will abide by and are bound by all conditions of entry as set out above.*

I agree that I and the child/ren for whom I am responsible will abide by and are bound by all conditions of entry as set out above.

Privacy Policy*

I agree to the privacy policy and I have produced my valid membership card*

Signature of Parent/Responsible Adult*

Name

This field is for validation purposes and should be left unchanged.