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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 under our care. As such, and in conjunction with the implementation of Rowan’s Law, we 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 has made available both in printed form as well as electronically (https://www.sgcc.on.ca/Curling/Rowan_s_Law) Concussion Awareness Resources. We would like to thank you for your time and effort in review of these documents and for your support of the Club's endeavour to mitigate the chances of such an injury.

Prior to your registration and participation within the sport of Curling at the Club annually, we ask you to provide your acknowledgement of receipt and review of the Concussion Awareness Resource material applicable to your age. For those under the age of 18, we ask that the parent or guardian of the participant acknowledge that they have reviewed this material with their dependent and sign on their behalf.

By completing and submitting this Acknowledgement of Receipt Form you confirm that you have received and reviewed the applicable Concussion Awareness Resources provided by the Club prior to your participation, or your dependent's participation in the sport of curling.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Age Verification for Rowan's Law Information *
10 Years of Age or Younger
11 - 14 Years of Age
15 Years of Age and Up
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Age Verification for Rowan's Law Information *
10 Years of Age or Younger
11 - 14 Years of Age
15 Years of Age and Up
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Age Verification for Rowan's Law Information *
10 Years of Age or Younger
11 - 14 Years of Age
15 Years of Age and Up
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Age Verification for Rowan's Law Information *
10 Years of Age or Younger
11 - 14 Years of Age
15 Years of Age and Up
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Age Verification for Rowan's Law Information *
10 Years of Age or Younger
11 - 14 Years of Age
15 Years of Age and Up
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Age Verification for Rowan's Law Information *
10 Years of Age or Younger
11 - 14 Years of Age
15 Years of Age and Up
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Age Verification for Rowan's Law Information *
10 Years of Age or Younger
11 - 14 Years of Age
15 Years of Age and Up
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Age Verification for Rowan's Law Information *
10 Years of Age or Younger
11 - 14 Years of Age
15 Years of Age and Up
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Age Verification for Rowan's Law Information *
10 Years of Age or Younger
11 - 14 Years of Age
15 Years of Age and Up
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Age Verification for Rowan's Law Information *
10 Years of Age or Younger
11 - 14 Years of Age
15 Years of Age and Up
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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Age Verification for Rowan's Law Information *
10 Years of Age or Younger
11 - 14 Years of Age
15 Years of Age and Up
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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