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Sarnia Golf & Curling Club (the "Club") understands the seriousness and long-term effects of concussions and has developed policies and procedures to help protect the Members, Employees, and Guests who attend the Club. As such, and in conjunction with the implementation of Rowan’s Law, we the Club hope to increase the awareness of those who participate in Curling at our facility of the risks associated with concussions, and procedures to be undertaken if one is suspected.

As a part of these efforts, the Club requires each participant, parent or guardian of a participant under the age of 18, Coaches, and Trainers to abide by a concussion specific Code of Conduct as it pertains to the sport of Curling.

I will help prevent concussions by:

  • Wearing the proper equipment for Curling and wearing it correctly.
  • Developing my skills and strength so that I can participate to the best of my ability.
  • Respecting the rules of Curling.
  • Maintaining my commitment to fair play and respect for all (respecting other athletes, coaches, team trainers and officials).

I will care for my health and safety by taking concussions seriously, and I understand that:

  • A concussion is a brain injury that can have both short and long-term effects.
  • A blow to my head, face or neck, or a blow to the body that causes the brain to move around inside the skull may cause a concussion.
  • I do not need to lose consciousness to have had a concussion.
  • I have a commitment to concussion recognition and reporting, including self-reporting of a possible concussion and reporting to a designated person when and individual suspects that another individual may have sustained a concussion. (Meaning: If I think I might have a concussion I should stop participating in further training, practice or competition immediately, or tell an adult if I think another athlete has a concussion).
  • Continuing to participate in further training, practice or competition with a possible concussion increases my risk of more severe, longer lasting symptoms, and increases my risk of other injuries.

I will not hide concussion symptoms. I will speak up for myself and others.

  • I will not hide my symptoms. I will tell a coach, official, team trainer, parent or another adult I trust if I experience any symptoms of concussion.
  • If someone else tells me about concussion symptoms, or I see signs they might have a concussion, I will tell a coach, official, team trainer, parent or another adult I trust so they can help.
  • I understand that if I have a suspected concussion, I will be removed from Curling and that I will not be able to return to training, practice or competition until I undergo a medical assessment by a medical doctor or nurse practitioner and have been medically cleared to return to training, practice or competition.  
  • I have a commitment to sharing any pertinent information regarding incidents of removal from Curling with any other sport organization with which I have registered (Meaning: If I am diagnosed with a concussion, I understand that letting all of my other coaches and trainers know about my injury will help them support me while I recover.)

I will take the time I need to recover, because it is important for my health.

  • I understand my commitment to supporting the return-to-sport process (I will have to follow Sarnia Golf and Curling Club’s Return-to-Sport Protocol).
  • I understand I will have to be medically cleared by a medical doctor or nurse practitioner before returning to training, practice or competition.
  • I will respect my coaches, team trainers, parents, health-care professionals, and medical doctors and nurse practitioners, regarding my health and safety.

I will help prevent concussions, through my:

  • Commitment to zero-tolerance for prohibited play that is considered high risk for causing concussions
  • Acknowledgement of mandatory expulsion from competition for violating zero-tolerance for prohibited play that is considered high risk for causing concussions (Meaning: I will be disqualified/expelled from play if I violate the zero-tolerance policy).
  • Acknowledgement of the escalating consequences for those who repeatedly violate the Concussion Code of Conduct.

By completing this form, I acknowledge that I have fully reviewed and commit to this Concussion Code of Conduct.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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