Authorized Adult Form

I give permission for the following adult(s) to bring and supervise the child listed below at The Bratt Cave bouldering gym. (Photo ID required at first-time check-in).

Key Terms

Waiver Required: A standard Youth Waiver signed by the Legal Guardian must already be on file.
Active Supervision: The authorized adult must supervise the child at all times.
Emergency Care: If I cannot be reached in an emergency, the authorized adult may consent to emergency medical treatment.
Duration: Valid through for 3 years from this date unless revoked in writing.

Fill out an additional form for each child and each Authorized Adult.

Your Information

First Name *

Last Name *

Your Date of Birth *

Mobile Number *

Authorized Adult Full Name:*

Authorized Adult Relationship to Child:*

Authorized Adult Phone Number:*

Child Information:

Add Another Name

Sign Here

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.