Please read the guidelines for climbing at Old Baldy, complete this form and return it together with your payment of $25 to the Grey Sauble Conservation Authority, R.R.#4, Owen Sound, Ontario N4K 5N6 (phone 519-376-3076), or fax it with your Visa or Mastercard number to 519-371-0437.
Indemnity and Release of Liability
I am an experienced rock climber.
In consideration of my being permitted to participate in the activity of recreational rock climbing at the old Bady conservation Area, I hereby for myself, my heirs, executors, administrators and assigns, release and forever discharge the Grey Sauble Conservation Authority, their officers, managers, servants, agents and volunteer leaders, (all of whom are now referred to as the G.S.C.A.) from any and all lawsuits or actions, claims or demands by reason of anv damage, loss, death or injury to myself or to my property arising from my participation in rock climbing notwithstanding that the same may have been contributed to or occasioned by the negligence of the G.S.C.A.
I agree to save, hold harmless and indemnify the G.S.C.A. from and against all lawsuits, claims, actions, costs or expenses in respect to any death,m injury, loss or damage to myself or my property howsoever caused arising out of or in connection with rock climbing whether the same may have been contributed to or occasioned by the negligence of the G.S.C.A.
I recognize and acknowledge that there are inherent risks and hazards involved with participation in rock climbing, including but not exclusively, such hazards as danger from avalanches, rock fall, sudden changes in weather, falls on steep terrain, failure of climbing equipment, and the possibility of becoming lost, as well as all other hazards associated with hiking, rock an ice climbing, mountaineering, wilderness travel and the other permitted activities of the G.S.C.A., and I agree to assume all such risks and hazards, and I further agree to bear all costs of rescue or medical attention rendered to me Personally.
I have read the Indemnity and Release of Liability and accept its terms.
I have read the attached rock climbing guidelines and agree to follow these guidelines.
I have enclosed my $25.00 administration fee for this one year permit. I understand that this permit expires on December 31 of the year it was purchased.
The personal information being collected on this form is for the sole purpose of permitting the Grey Sauble Conservation Authority to undertake a project as defined in accordance with Conservation Authorities Act, R.S.O. 1990. During the review, approval, implementation and future monitoring of this project, it is possible that some or all of this personal information may become part of the public record. Questions about this collection should be directed to the Freedom of Information and Privacy Co-ordinator at the address above.
I recognize and accept this fact in releasing this information.
Date: _____________________________________
Signature: _____________________________________
Name (Please print clearly): ___________________________________
Address: ____________________________________________________
City: __________________________ Postal Code: ____________
Tel (home): (_____)_______________ (work): (_____)_______________
Credit Card: Visa ___ Mastercard ___
Card number: _________________________ Expiry Date: _________
I hereby authorize you to debit my credit card for this climbing permit.
Signature: _____________________________________