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The Arch Climbing Wall - Under 12 Parent / guardian supervisor form

Name of Supervisor:

First Name

Last Name

Date of Birth:

DD/MM/YYYY

Has the customer previously had EITHER an introduction session OR safety briefing?

Yes

If 'NO', do not proceed and advise the customer to return after session OR start the safety briefing?

Checklist below to be completed by staff after posing the questions to the customer verbally.

The supervisor must be able to answer the flashcard, controlled fall & injury, and supervision questions without prompting. Discussion of the Further Questions is permitted but the need give advice to multiple questions should be considered indicative of the lack of experience necessary to supervise an Under 12. Acceptable answers are given in the accompanying documentation to this form.

A. Flashcard questions

(Please proceed with the flashcard questions)

B. Controlled fall & injury questions

How should your Under 12 attempt to land on the matting?

Name two common injuries that occur when climbing?

How can you prevent these injuries from happening?

C. Supervision questions

Can an Under 12 be left unsupervised in any of the climbing areas?

If supervising an Under 12, should you also be on the wall at the same time as them?

Does the matting under the climbing walls prevent all injuries for a falling climber?

Where would you NOT leave personal belongings (inc. drinks)? Why?

Supervisor's declaration: I confirm that I have been briefed by or have completed an induction given to me by a member of staff at The Arch Climbing Wall. I confirm that the answers given reflect my knowledge and ability to supervise an Under 12.

Supervisor/guardian signature:

(Full Name)

Date:

DD/MM/YYYY

Staff member signature

(Full Name)

Date:

DD/MM/YYYY

The Arch Climbing Wall - Under 12 Parent / guardian supervisor form

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