Racine Curling Club Waiver

Our club waiver is totally digital- no more paper! Please fill out the below waiver prior to going out on the ice.

Waiver

ACKNOWLEDGEMENT, RELEASE, WAIVER AND INDEMNITY AGREEMENT (Curling and Other Activities at the Curling Club)

"*" indicates required fields

Age

Youth Waiver

The undersigned, being a parent or legal guardian of the minor curler ("Minor") indicated below, hereby makes the following representations: (i) that the undersigned is legally responsible for the Minor and legally empowered to act for, on behalf of, and to execute this Participant Release and thereby bind the Minor; (ii) that the Minor will comply with the rules and regulations of the Releasees (as defined below); (iii) that the undersigned understands that the sport of curling is played on ice and requires physical fitness; (iv) that the Minor possesses such physical fitness; and (v) that the undersigned understands that the risks of the Minor participating in any curling activity could involve serious injury or death.

In consideration of the Minor being allowed access to the Ice House (as defined below) as a participant in any curling activity in the Ice House, I, the undersigned, for the Minor and the Minor's estate, successors, heirs, beneficiaries, administrators, trustees, representatives, and attorneys do hereby remise, release, acquit, and forever discharge (i) Racine Curling Club, a Wisconsin corporation (the "Club"); (ii) the United States Curling Association, Inc. ("USCA"); (iii) Wisconsin State Curling Association ("WSCA"); (iv) the respective successors and assigns or each of the Club, USCA, and WSCA; and (v) the respective employees, officers, and directors, but only while acting in their capacity as such, of each of the Club, USCA, and WSCA (collectively, the "Releasees") from any and all actions, causes of action, claims, demands, and liabilities, both in law and equity for damages and any court costs and legal expenses and fees associated therewith in respect of physical, mental, and bodily injury occurring to the Minor while participating in any curling activity in the Ice House prior to the Expiration Date (as defined below); provided, however, that in the event such injury was caused, in whole or in part, by the willful, intentional, reckless, or grossly negligent action or failure to take action of any Releasee, such Releasee shall not be so remised, released, acquitted, or discharged hereby; and provided, further, that nothing herein shall be deemed to limit or exclude any action, cause of action, claim, demand, liability, payment, reimbursement, other benefit, or any cou1t costs or legal expenses and fees that the Minor or the Minor's estate, successors, heirs, beneficiaries, administrators, trustees, representatives, or attorneys might have or seek against (a) the Club's "Participant Medical Accident" insurance coverage, (b) any other participant participating in any curling activity in the Ice House, or ( c) against any other person or entity other than a Releasee.

The Ice House shall mean the single room containing two (2) sheets of ice in which the spo1t of curling is played in the building located at 1914 Melvin Av., Racine, Wisconsin owned and operated by Club. The Expiration Date shall mean the date which is one (1) calendar year after the date this Release is executed below.

In the case that the Minor requires urgent medical attention and I cannot be reached, I hereby authorize (i) emergency personnel and medical practitioners selected by any of the Releasees or other chaperone of the Minor, in their reasonable judgment and sole discretion, to take any and all necessary measures on behalf of the Minor and (ii) the disclosure of the information set forth below to emergency personnel and medical practitioners by any of the Releasees or other chaperone of the Minor.

I hereby revoke any and all releases of liability, waivers, and indemnifications previously executed by me in favor of any of the Releasees.

Name of Parent/Guardian*

First Last

Name of Minor*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone*

Secondary Phone

If applicable

Medical Insurance Carrier & Group Number

Please complete this if the minor will be in the Ice House while parent/guardian is not present

Emergency Contact Name, Relationship & Phone

Please complete this if the minor will be in the Ice House while parent/guardian is not present

Allergies, Medical Conditions, Current Medications

Please complete this if the minor will be in the Ice House while parent/guardian is not present

Waiver Details

The undersigned hereby makes the following representations: (i) that the undersigned understands that the sport of curling is played on ice and requires physical fitness; (ii) that the undersigned possesses such physical fitness; and (iii) that the undersigned understands that the risks of participating in any curling activity could involve serious injury or death. In consideration of being allowed access to the Ice House (as defined below) as a participant in any curling activity in the Ice House, I, the undersigned, for myself and my estate, successors, heirs, beneficiaries, administrators, trustees, representatives, and attorneys do hereby remise, release, acquit, and forever discharge (i) Racine Curling Club, a Wisconsin corporation (the “Club”); (ii) the United States Curling Association, Inc. (“USCA”); (iii) the Wisconsin State Curling Association (“WSCA”); (iv) the respective successors and assigns or each of the Club, USCA, and WSCA, and (v) the respective employees, officers, and directors, but only while acting in their capacity as such, of each of the Club, USCA, and WSCA (collectively, the “Releasees”) from any and all actions, causes of actions, claims, demands, and liabilities, both in law and equity for damages and any court costs and legal expenses and fees associated therewith in respect of physical, mental, and bodily injury occurring to me while participating in any curling activity in the Ice House prior to the Expiration Date (as defined below); provided, however, that in the event such injury was caused, in whole or in part, by the willful, intentional, reckless, or grossly negligent action or failure to take action of any Releasee, such Releasee shall not be so remised, released, acquitted, or discharged hereby; and provided further, that nothing herein shall be deemed to limit or exclude any action, cause of action, claim, demand, liability, payment, reimbursement, other benefit, or any court cost or legal expenses and fees that I or my estate, successors, heirs, beneficiaries, administrators, trustees, representatives, or attorneys might have or seek against (a) the Club’s “Participant Medical Accident” insurance coverage, (b) any other participant participating in any curling activity in the Ice House, or (c) against any other person or entity other than a Releasee.

The Ice House shall mean the single room containing two (2) sheets of ice in which the sport of curling is played in the building located at 1914 Melvin Avenue, Racine, Wisconsin owned and operated by the Club. The expiration date shall mean the date which is one (1) calendar year after the date this Release is executed below.:

Racine Curling Club, a Wisconsin non-profit corporation has put in place certain precautionary practices and safety measures to reduce the risks, dangers, and hazards of participating in the Activities. Racine Curling Club reserves the right to adjust and implement different precautionary practices based on its discretion and as necessary to decrease the risk of serious personal injury, disability, or death. Racine Curling Club recommends the following precautionary practices:

Warm up properly before playing. Allow time to stretch and warm up to reduce the risk of strain or stretch injuries.
Wear warm, athletic layers that are comfortable and allow movement. Jeans are not recommended. Thin gloves may help prevent blisters and injury while sweeping. The icehouse is kept at approximately 40°F.
Wear clean-soled athletic shoes with good traction on ice to help keep the ice safe and clean.
Safety headgear is recommended for all participants.
Use your broom or brush appropriately. Use your broom or brush to help keep your balance and avoid falls, both when you are getting on and off the ice and while playing. Use your broom or brush to stop the rocks.
Step on to the ice with your gripper foot; never step onto the ice with your slider foot.
Step off the ice with your slider foot; never step off the ice with your gripper foot.
Ice conditions can change frequently. Note how slippery the ice is when you first step on and use extra caution if necessary.
Keep your feet on the ice. Walk or slide – Never hop or run.
Keep focused on the game. Be aware of where the rocks and equipment are.
Illness and alcohol can affect your balance the effects will be much more noticeable on the slippery ice. Avoid playing if your balance is impaired in any way.
Follow any additional rules, regulations, or procedures given to you by Racine Curling Club instructors or posted in the icehouse.

Informed Consent and Assumption of Risk Acknowledgement*

I acknowledge that the Activities are potentially dangerous and involve risks of serious personal injury, disability, and/or death.

I acknowledge that the risks include, but are not limited to, slipping and falling on icy surfaces, including both the curling rink and other surfaces; variations in ice conditions on the curling rink; subfreezing temperatures; collisions with other patrons; collisions with objects, including walls around the curling rink, and equipment, including curling brooms and curling stones; defective equipment; sudden on-ice movements or stops; and physical overexertion.

I accept the risks associated with the Activities, including both risks known and unknown, in order to utilize Racine Curling Club's facilities.

I acknowledge that some risks associated with the Activities may arise from the negligent actions or omissions from other patrons or Racine Curling Club members, managers, agents, directors, officers, or employees.

I acknowledge that there are ways to greatly reduce certain risks associated with the Activities, including by being physically fit, wearing a helmet, training, or taking lessons, and using common sense.

I believe I have been adequately informed of the risks associated with participating in the Activities. If I did not believe I was adequately informed of such risks, I would not sign this Acknowledgment, Release, Waiver, and Indemnity Agreement.

BEFORE SIGNING BELOW, I WAS GIVEN THE OPPORTUNITY TO READ THIS PARTICIPANT RELEASE AND TO CONSULT WITH AN ATTORNEY AS TO ITS SIGNIFICANCE. BY SIGNING BELOW, I UNDERSTAND THAT I AM WAIVING SIGNIFICANT RIGHTS. I UNDERSTAND THE MEANING OF THIS PARTICIPANT RELEASE AND THE RIGHTS I AM WAIVING. NOTWITHSTANDING THE FOREGOING, I HAVE CHOSEN, OF MY OWN FREE WILL TO EXECUTE THIS PARTICIPANT RELEASE.

Name*

First Last

Agreement Checkboxes*

I WAIVE MY RIGHT TO AMEND THE TERMS OF THIS ACKNOWLEDGMENT AND RELEASE.

Signatures delivered by electronic means will be deemed to be and will treated for all purposes as original signatures.

I agree to these terms.

Signature*

By signing above, I acknowledge that I have read and understand the terms and provisions of this Release, I appreciate its legal significance, and I sign this Release voluntarily.

Phone

This field is for validation purposes and should be left unchanged.

Waiver

Youth Waiver

Waiver Details

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