SGCC Little Rockers Curling Registration

This form must be completed no later than October 13, 2023.

***Little Rockers is for anyone 8 to 13 years of age as of December 31, 2023***

***CSA-Approved helmets are mandatory for participants under the age of 12***

Personal Information

First Name *

Last Name *

Address *

City/Town *

Province *

Postal Code *

Email Address *

Date of Birth *

Gender *

School *

Curling Experience *

None	# of Years # of Years

Health Card Number

Family Doctor

Family Doctor Telephone

Allergies

+-

Parental/Guardian/Emergency Contact Information

Parent

Telephone

Email

Parent

Telephone

Email

Other

Telephone

Email

Is a parent/grandparent/guardian a member of the Sarnia Golf & Curling Club? *

Yes

No

Please indicate if you are willing to volunteer with any aspects of our program: (select all that apply)

Coach - Instructor

Coach - Off Ice Supervision

Coach - On Ice Supervision

VOLUNTEERS/COACHES

Required Waivers

By checking this box, you are confirming that all applicable waivers found below have been electronically signed and submitted before being able to participate.

Rowan's Law Concussion Code of Conduct - Coaches and Trainers

Waiver/Acknowledgement of Risk for Adults

Payment Information

Registration Fee: *

Total Owing:

0.00

Credit Card Type

Name on Card

Credit Card Number

Expiration Date (mm/yy)

or, bill to Member Account:

Form Submission

Required Waivers *

By checking this box, you are confirming that all applicable waivers found below have been electronically signed and submitted before being able to participate.

CURLING MEMBERS UNDER 18

Waiver/Acknowledgement of Risk for Minors

Rowan's Law Concussion Awareness Code of Conduct

Rowan's Law Acknowledgement of Receipt

Player Agreement:

I agree to abide by all rules and regulations as laid out by the Sarnia Golf & Curling Club (“the Club”) and by its Affiliates. I further agree to obey those in charge of my team, to respect all officials, to refrain from using profanity, to respect all Sarnia Golf & Curling Club property, and to conduct myself as an athlete and a gentleman/lady at all times. I agree to accept the responsibilities of being a good Club member.

Date of Submission * +

Player Signature *

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Parent/Guardian Agreement:

When your son or daughter is placed on a team each week, the other players will expect him or her to live up to his or her responsibilities as a good team member. If you feel that he or she can meet these requirements, please fill out the following:

I hereby declare that I am willing to allow my son or daughter to curl and will not hold the Sarnia Golf & Curling Club Limited, its agents, executive, volunteers, employees, or sponsors, responsible for injuries incurred by my son or daughter as a member of the Sarnia Golf & Curling Club Limited.

All equipment supplied is the property of the Sarnia Golf & Curling Club and must remain at the Sarnia Golf & Curling Club at all times unless participating within the Club’s equipment lending program.

Note: Please inform coaches of any health concerns.

Date of Submission * +

Parent/Guardian Signature *

clear