UNSUPERVISED ROPED CLIMBING AND BOULDERING

ADULT REGISTRATION FORM (18 + OVER)

You MUST complete ALL fields and watch the safety induction video before you can submit this form.

Once you are finished this form will be emailed to our reception and your membership will be reviewed. On arriving at the centre you should follow any COVID safety restirctions in place, use the anti-bacterial gel in main reception entrance and queue. Please ensure you follow Government social distancing guidelines and help us keep Creation open, and safe.

At reception inform the receptionist you have completed an online registration form and they will locate your membership request.
Competent climbers will need to perform a belay demonstration before being allowed to roped climb unsupervised.

All users are required to pay the annual membership fee of £3.75

Our system has generated your unique membership number as:    web counter free
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Please enter your unique membership number as shown above: *
Full Name: *
House Number & Street Name: *
Town: *
Post Code: *
Date of Birth (DD/MM/YY): *
Telephone Number: *
Emergency Number (required): *
Please supply your email address so that we can send you your membership confirmation: *
If you are a student please enter the expiry date of your
University course, as shown on your student ID card:
Employment Status:  *
 
To receive Concession rate for unemployment you will need to provide proof of unemployment.
Have you read and understood the Conditions of Use

and Rules of the Centre?

  *
Do you agree to the conditions of use?  *
You understand that failure to exercise due care

could result in injury or death to you or others?

  *
Do you have any questions regarding the conditions of use?  *
Do you agree to abide by the rules of the climbing centre?  *
I agree to only participate in activities that I am

competent to undertake:

  *
BY ANSWERING YES YOU CONFIRM THAT YOU ARE PREPARED TO PROVIDE

A PHYSICAL DEMONSTATION ON THE REQUIREMENTS AS SET OUT BELOW:

  *
If you can not do this or feel unsure you should STOP completing this form and start a NOVICE form
I understand that if staff are not satisifed with my belay test that I will not be
permitted to use the roped climbing unsupervised:
  *
Can you put on a climbing harness?:  *
 
Can you attach a rope to your harness using a suitable climbing knot?:  *
 
Can you use a belay device to secure a falling climber and lower a climber from the wall?:  *
 
DECLARATION OF FITNESS: I certify that I do not suffer from a medical condition which might have the effect of making it more likely that I may be involved in an accident,

which could result in injury to others or myself:

  *
DECLARATION OF FACT: I also confirm that the above information is

correct and if any information changes I will notify the centre immediately.:

  *
ELECTRONIC SIGNATURE: By clicking the 'AGREE' button you confirm the

details on this form are correct and that the tick box replaces your written signature:

  *