Loading...

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, the Club hopes 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 can help prevent concussions through my:

  • Efforts to ensure that my athletes wear the proper curling equipment and wear it correctly.
  • Efforts to help my athletes develop their skills and strength so they can participate to the best of their abilities.
  • Respect for the rules of my sport or activity and efforts to ensure that my athletes do, too.
  • Commitment to fair play and respect for all (respecting other coaches, team trainers, officials and all participants and ensuring my athletes respect others and play fair).

I will care for the health and safety of all participants by taking concussions seriously. I understand that:

  • A concussion is a brain injury that can have both short- and long-term effects.
  • A blow to the head, face, or neck, or a blow to the body may cause the brain to move around inside the skull and result in a concussion.
  • A person doesn’t need to lose consciousness to have had a concussion.
  • An athlete with a suspected concussion should stop participating in training, practice or competition immediately.
  • I have a commitment to concussion recognition and reporting, including self-reporting of possible concussion and reporting to a designated person when an individual suspects that another individual may have sustained a concussion.
  • Continuing to participate in further training, practice or competition with a suspected concussion increases a person’s risk of more severe, longer lasting symptoms, and increases their risk of other injuries or even death.

I will create an environment where participants feel safe and comfortable speaking up. I will:

  • Encourage athletes not to hide their symptoms, but to tell me, an official, parent or another adult they trust if they experience any symptoms of concussion after an impact.
  • Lead by example. I will tell a fellow coach, official, team trainer and seek medical attention by a physician or nurse practitioner if I am experiencing any concussion symptoms.
  • Understand and respect that any athlete with a suspected concussion must be removed from sport and not permitted to return until they undergo a medical assessment by a physician or nurse practitioner and have been medically cleared to return to training, practice or competition.
  • For coaches only: Commit to providing opportunities before and after each training, practice and competition to enable athletes to discuss potential issues related to concussions.

I will support all participants to take the time they need to recover.

  • I understand my commitment to supporting the return-to-sport process.
  • I understand the athletes will have to be cleared by a physician or nurse practitioner before returning to sport. 
  • I will respect my fellow coaches, team trainers, parents, physicians and nurse practitioners and any decisions made with regards to the health and safety of my athletes.

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.
  • 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 Coach's or Trainer's Name

First Name*

Last Name*

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

First Name*

Last Name*
Second Coach's or Trainer's Date of Birth*
Third Coach's or Trainer's Name

First Name*

Last Name*
Third Coach's or Trainer's Date of Birth*
Fourth Coach's or Trainer's Name

First Name*

Last Name*
Fourth Coach's or Trainer's Date of Birth*
Fifth Coach's or Trainer's Name

First Name*

Last Name*
Fifth Coach's or Trainer's Date of Birth*
Sixth Coach's or Trainer's Name

First Name*

Last Name*
Sixth Coach's or Trainer's Date of Birth*
Seventh Coach's or Trainer's Name

First Name*

Last Name*
Seventh Coach's or Trainer's Date of Birth*
Eighth Coach's or Trainer's Name

First Name*

Last Name*
Eighth Coach's or Trainer's Date of Birth*
Ninth Coach's or Trainer's Name

First Name*

Last Name*
Ninth Coach's or Trainer's Date of Birth*
Tenth Coach's or Trainer's Name

First Name*

Last Name*
Tenth Coach's or Trainer'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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!