PARTICIPANT AGREEMENT, RELEASE, AND ACKNOWLEDGEMENT OF RISK

In consideration of the services of Jonathan Salem Doing Business As EverClimb USA, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "EC USA”), I hereby agree to release and discharge EC USA, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:

                1.  I acknowledge that climbing on an artificial climbing wall entails known and unanticipated risks which could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties.  I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.
               
The risks include, among other things:  falling off the wall; loose and/or damaged artificial holds; falling to the ground, on other users, or being fallen on by other users; abrasions from the walls, ropes, pads, concrete, asphalt, dirt, ground or floor; of other climbers, visitors, participants, or other persons who may be present; musculoskeletal injuries and/or overtraining; head injuries; or my own negligence.

                Furthermore, EC USA employees and staff have difficult jobs to perform.  They seek safety, but they are not infallible.  They might be ignorant of a participant’s fitness or abilities.  They may give inadequate warnings or instructions, and the equipment being used might malfunction.

                2.  I expressly agree and promise to accept and assume all of the risks existing in this activity.  My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

                3.  I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless EC USA from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of EC USA's equipment or facilities, including any such Claims which allege negligent acts or omissions of EC USA.

                4.  Should EC USA or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

                5.  I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself.  I further certify that I have no medical or physical conditions which could interfere with my safety in this activity, or else I am willing to assume -- and bear the costs of -- all risks that may be created, directly or indirectly, by any such condition.

                6.  In the event that I file a lawsuit against EC USA, I agree to do so solely in the State of Florida, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against EC USA on the basis of any claim from which I have released them herein.

I have had sufficient opportunity to read this entire document.  I have read and understood it, and I agree to be bound by its terms.

____________________________________                        __________________________________            ____________
Signature of Participant                                                          Print Name                                                              Date

PARENTS OR GUARDIAN'S ADDITIONAL INDEMNIFICATION
(Must be completed for participants under the age of 18)

In consideration of _______________________(print minor's name) ("Minor") being permitted by EC USA to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless EC USA from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.

Parent or Guardian: ____________________________

Print Name:_____________________________

Date: ___________

Please print clearly

First Name__________________________ Middle Initial____ Last Name_______________________

Home Phone________________ Work Phone______________

E-mail address_____________________________

Date of Birth___________ Sex ____ Profession _______________________

Fax _________________________

Address_______________________________________ City______________ State___ Zip______

Emergency Contact Information

First Name__________________________ Middle Initial____ Last Name_____________________

Home Phone________________________________ Work Phone__________________________

Address_______________________________________ City______________ State___ Zip______

Medical Information

Do you have any medical conditions? Yes / No If so, explain:

_______________________________________________________________________________________________________________________

Do you have any allergies? Yes / No If so, explain:

_______________________________________________________________________________________________________________________

Are you taking any medication? Yes / No If so, explain:

_______________________________________________________________________________________________________________________

Do you have any dietary restrictions? Yes / No If so, explain:

_______________________________________________________________________________________________________________________

Do you carry medical insurance? Yes / No If so, insurance company or provider:

_______________________________________________________________________________________________________________________

By signing this I attest that the above information is true and correct.

Signature: ____________________________________________ Date:_________________________________________

How did you come to hear about EverClimb USA ? ___________________________________________________________________________