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ADULT PARTICIPANT RELEASE

     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) Cincinnati Curling Club, a Ohio 501c3 NONPROFIT CORPORATION (the “Club”); (ii) the United States Curling Association, Inc. (“USCA”); (iii) the Great Lakes Curling Assocation (“GLCA”); (iv) the respective successors and assigns or each of the Club, USCA, and MARTINI ON ICE, LLC dba SPORTS PLUS and CITY OF BLUE ASH (the “Arena(s)”) and (v) the respective employees, officers, and directors, but only while acting in their capacity as such, of each of the Club, USCA, and the Arena(s) (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 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 costs 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 arena building(s) containing the ice rink(s) in which the sport of curling is played located at 10765 Reading Road, Cincinnati, OH, and at Summit Park in Blue Ash, 4335 Glendale Milford Rd, Blue Ash, OH, 45242, owned and operated by the Arena(s). The Expiration Date shall mean the date which is one (1) calendar year after the date this Release is executed below.

    I certify that I am at least eighteen (18) years of age and have the legal capacity to execute this Participant Release on my own behalf.

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

    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.


Date: January 15, 2019

First Member's Name

First Name*

Last Name*

Phone*
First Member's Date of Birth*
First Member's Information

Thank you for joining Cincinnati Curling Club for 2018-2019. Please enter the member information below. Your membership information will be submitted to United States Curling Association. Each person who will be out on the ice should fill out a separate waiver/membership form.


Address 1: *

Address 2:

City *

State *

Zip *
Nametags
I already have a nametag
I need a nametag that says (enter in textbox below)

Name for nametag (typically your first name)

Membership Dues for 2018-2019 are as follows (league fees are an additional cost):

Adult Member: $85


First Member's Signature*
Second Member's Name

First Name*

Last Name*
Second Member's Date of Birth*
Second Member's Information

Thank you for joining Cincinnati Curling Club for 2018-2019. Please enter the member information below. Your membership information will be submitted to United States Curling Association. Each person who will be out on the ice should fill out a separate waiver/membership form.


Address 1: *

Address 2:

City *

State *

Zip *
Nametags
I already have a nametag
I need a nametag that says (enter in textbox below)

Name for nametag (typically your first name)

Membership Dues for 2018-2019 are as follows (league fees are an additional cost):

Adult Member: $85


Third Member's Name

First Name*

Last Name*
Third Member's Date of Birth*
Third Member's Information

Thank you for joining Cincinnati Curling Club for 2018-2019. Please enter the member information below. Your membership information will be submitted to United States Curling Association. Each person who will be out on the ice should fill out a separate waiver/membership form.


Address 1: *

Address 2:

City *

State *

Zip *
Nametags
I already have a nametag
I need a nametag that says (enter in textbox below)

Name for nametag (typically your first name)

Membership Dues for 2018-2019 are as follows (league fees are an additional cost):

Adult Member: $85


Fourth Member's Name

First Name*

Last Name*
Fourth Member's Date of Birth*
Fourth Member's Information

Thank you for joining Cincinnati Curling Club for 2018-2019. Please enter the member information below. Your membership information will be submitted to United States Curling Association. Each person who will be out on the ice should fill out a separate waiver/membership form.


Address 1: *

Address 2:

City *

State *

Zip *
Nametags
I already have a nametag
I need a nametag that says (enter in textbox below)

Name for nametag (typically your first name)

Membership Dues for 2018-2019 are as follows (league fees are an additional cost):

Adult Member: $85


Fifth Member's Name

First Name*

Last Name*
Fifth Member's Date of Birth*
Fifth Member's Information

Thank you for joining Cincinnati Curling Club for 2018-2019. Please enter the member information below. Your membership information will be submitted to United States Curling Association. Each person who will be out on the ice should fill out a separate waiver/membership form.


Address 1: *

Address 2:

City *

State *

Zip *
Nametags
I already have a nametag
I need a nametag that says (enter in textbox below)

Name for nametag (typically your first name)

Membership Dues for 2018-2019 are as follows (league fees are an additional cost):

Adult Member: $85


Sixth Member's Name

First Name*

Last Name*
Sixth Member's Date of Birth*
Sixth Member's Information

Thank you for joining Cincinnati Curling Club for 2018-2019. Please enter the member information below. Your membership information will be submitted to United States Curling Association. Each person who will be out on the ice should fill out a separate waiver/membership form.


Address 1: *

Address 2:

City *

State *

Zip *
Nametags
I already have a nametag
I need a nametag that says (enter in textbox below)

Name for nametag (typically your first name)

Membership Dues for 2018-2019 are as follows (league fees are an additional cost):

Adult Member: $85


Seventh Member's Name

First Name*

Last Name*
Seventh Member's Date of Birth*
Seventh Member's Information

Thank you for joining Cincinnati Curling Club for 2018-2019. Please enter the member information below. Your membership information will be submitted to United States Curling Association. Each person who will be out on the ice should fill out a separate waiver/membership form.


Address 1: *

Address 2:

City *

State *

Zip *
Nametags
I already have a nametag
I need a nametag that says (enter in textbox below)

Name for nametag (typically your first name)

Membership Dues for 2018-2019 are as follows (league fees are an additional cost):

Adult Member: $85


Eighth Member's Name

First Name*

Last Name*
Eighth Member's Date of Birth*
Eighth Member's Information

Thank you for joining Cincinnati Curling Club for 2018-2019. Please enter the member information below. Your membership information will be submitted to United States Curling Association. Each person who will be out on the ice should fill out a separate waiver/membership form.


Address 1: *

Address 2:

City *

State *

Zip *
Nametags
I already have a nametag
I need a nametag that says (enter in textbox below)

Name for nametag (typically your first name)

Membership Dues for 2018-2019 are as follows (league fees are an additional cost):

Adult Member: $85


Ninth Member's Name

First Name*

Last Name*
Ninth Member's Date of Birth*
Ninth Member's Information

Thank you for joining Cincinnati Curling Club for 2018-2019. Please enter the member information below. Your membership information will be submitted to United States Curling Association. Each person who will be out on the ice should fill out a separate waiver/membership form.


Address 1: *

Address 2:

City *

State *

Zip *
Nametags
I already have a nametag
I need a nametag that says (enter in textbox below)

Name for nametag (typically your first name)

Membership Dues for 2018-2019 are as follows (league fees are an additional cost):

Adult Member: $85


Tenth Member's Name

First Name*

Last Name*
Tenth Member's Date of Birth*
Tenth Member's Information

Thank you for joining Cincinnati Curling Club for 2018-2019. Please enter the member information below. Your membership information will be submitted to United States Curling Association. Each person who will be out on the ice should fill out a separate waiver/membership form.


Address 1: *

Address 2:

City *

State *

Zip *
Nametags
I already have a nametag
I need a nametag that says (enter in textbox below)

Name for nametag (typically your first name)

Membership Dues for 2018-2019 are as follows (league fees are an additional cost):

Adult Member: $85


Parent or Guardian's Email Address

Email
Please DO NOT provide my email address to USCA. Cincinnati Curling Club communicates mainly by email. If you check this box, as a member, you will still be added to our email list to ensure you receive all club information.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Thank you for joining Cincinnati Curling Club for 2018-2019. Please enter the member information below. Your membership information will be submitted to United States Curling Association. Each person who will be out on the ice should fill out a separate waiver/membership form.


Address 1: *

Address 2:

City *

State *

Zip *
Nametags
I already have a nametag
I need a nametag that says (enter in textbox below)

Name for nametag (typically your first name)

Membership Dues for 2018-2019 are as follows (league fees are an additional cost):

Adult Member: $85


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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