Schenectady Curling Club Youth Curling

ACKNOWLEDGEMENT, AUTHORIZATION, ASSUMPTION OF RISK AND WAIVER OF LIABILITY

The undersigned, being a parent/legal guardian of the below-named minor prospective youth curler, hereby acknowledge(s) that said minor seeks to participate in a program sponsored by Schenectady Curling Club. (“SCC”) for youth curlers.

The undersigned specifically assert(s):

1. That the undersigned is/are the party(ies) who is/are legally responsible for said minor and is/are legally empowered to act for and on behalf of said minor.
2. That the said minor will comply with the rules and regulations of the SCC.
3. That the undersigned is/are aware that the sport of curling, like any athletic participation, requires physical fitness and the said minor possesses such fitness.
4. And, the undersigned understand(s) that there is some risk involved in curling because of the danger of slipping or falling on the ice surface on which the sport is played.

The undersigned specifically acknowledge(s) that a risk of injury exists and assume(s) said risk on behalf of said minor with respect to his/her participation in the SCCs Youth Curling Program. In the event that said minor attends curling and related events (whether held in conjunction with the SCC Youth Curling Program, the SCC generally, or otherwise) at (i) curling clubs other than the SCC or (ii) other venues which are not part of the SCC facilities, then, in consideration of the SCC’ participation in or sponsorship of such event, or the SCC’ provision of transportation to such event or other assistance in connection with or resulting from such event, the undersigned (a) agree(s) to defend and hold harmless the SCC, its officers, directors, agents, and chaperones from any claim, action, or suit involving said minor related to or resulting from such event and (b) grant(s) to the SCC, its officers, directors, agents, and chaperones a waiver of liability as regards any injury which should occur to said minor arising out of or resulting from his/her participation in such event.

NAME OF YOUTH CURLER_________________________________________________

DATE OF BIRTH_________________________________AGE____________________

STREET ADDRESS______________________________________________________

CITY, STATE, ZIP CODE__________________________________________________

TELEPHONE_________________________NUMBER OF YEARS CURLED____________

E-MAIL(s)_____________________________________________________________

EMERGENCY CONTACT

NAME/TELEPHONE_______________________________________________________

PARENT OR GUARDIAN (PLEASE PRINT)______________________________________

SIGNATURE____________________________________________________________

DATE______________________________