New Membership Form – Appleton Curling Club

New Account Setup

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User Information

Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

Sex

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Age

Address(Required)

Street Address Address Line 2 City State ZIP Code

Membership Type/Discounts(Required)

Click here for more detailed information about membership levels and discounts

Year You Started Curling(Required)

Parent/ Legal Guardian

Parent/ Legal Guardian Name

First Last

Parent/ Legal Guardian Phone

Parent/ Legal Guardian Email

Parent/ Legal Gardian Consent

As the Parent/ Legal Gardian I agree to the below.

The undersigned, being a parent or legal guardian of the minor curler (“Minor”) indicated below,
hereby makes the following representations: (i) that the undersigned is legally responsible for the Minor and legally empowered to act for, on behalf of, and to execute this Participant Release and thereby bind the Minor; (ii) that the Minor will comply with the rules and regulations of the Releasees (as defined below); (iii) that the undersigned understands that the sport of curling is played on ice and requires physical fitness; (iv) that the Minor possesses such physical fitness; and (v) that the undersigned understands that the risks of the Minor participating in any curling activity could involve serious injury or death.

In consideration of the Minor 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 the Minor and the Minor’s estate, successors, heirs, beneficiaries, administrators, trustees, representatives, and attorneys do hereby remise, release, acquit, and forever discharge (i) Appleton Curling Club, a Wisconsin Corporation (the “Club”); (ii) the United States Curling Association, Inc. (“USCA”); (iii) the Wisconsin State Curling Association (“WSCA”); (iv) the respective successors and assigns or each of the Club, USCA, and WSCA; and (v) the respective employees, officers, and directors, but only while acting in their capacity as such, of each of the Club, USCA, and WSCA (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 the Minor while the Minor is at the Ice House or in any adjacent area within the building in which the Ice House is located (the “Building”) in connection with any activity in the Ice House; 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 the Minor or the Minor’s 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, with respect to any Building, any single room containing sheets of ice in which the sport of curling is played in such Building, which Ice House is owned and /or operated by the Club.

In addition to this document, I agree the Minor will abide by all Club policies. These may include temporary health and safety protocols. I have been given the opportunity to review these and understand their significance. Willful negligence regarding these polices may result in the Minor being asked to leave the Building.

In the case that the Minor requires urgent medical attention and I cannot be reached, I hereby
authorize (i) emergency personnel and medical practitioners selected by any of the Releasees or other chaperone of the Minor, in their reasonable judgment and sole discretion, to take any and all necessary measures on behalf of the Minor and (ii) the disclosure of the information set forth below to emergency personnel and medical practitioners by any of the Releasees or other chaperone of the Minor. I hereby revoke any and all releases of liability, waivers, and indemnifications previously executed by me in favor of any of the Releasees. The invalidity or unenforceability of any provision of this Release shall not affect the validity or enforceability of any other provision of this Release, which shall remain in full force and effect. If any provision contained in this Release is found to be unenforceable by reason of the extent, duration or scope thereof, or otherwise, then the court making such determination shall have the right to reduce such extent, duration, scope or other provision so that in its reduced form any such restriction shall thereafter be enforceable to the maximum extent permitted by law.

Volunteer Hour Fee

I met my previous year's hours

Yes

N/A

Volunteer Hour Fee

Price:

Locker Fee

Are you renewing or want a locker?

Renewing Locker

Add me to the Waiting list

N/A

Locker Fee

Price:

Optional Donation

Would you like to donate an addtional amount?

$50

$100

$200

$300

Waiver & Emergency Contact Information

Emergency Contact Name(Required)

Emergency Contact Phone(Required)

Emergency Contact Relation(Required)

Information Waiver(Required)

I agree to the Consent to Release Information, Privacy Policy and Anti-Spam Policy.

I hereby consent to the use of the personal information provided above by the Club Administration. Only my name and phone number(s) will be listed in the membership directory and/or website for general member use. This information is intended for the sole use of the Club and will not be shared outside the Club.

Injury Waiver(Required)

I agree to the Injury Waiver.

ADULT PARTICIPANT RELEASE ACCEPTANCE

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) Appleton Curling Club a Wisconsin Corporation (the “Club”); (ii) the United States Curling Association, Inc. (“USCA”); (iii) the WSCA (iv) the respective successors and assigns or each of the Club, USCA, and WSCA and (v) the respective employees, officers, and directors, but only while acting in their capacity as such, of each of the Club, USCA, and WSCA (collectively, the “Releases”) 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 wilful, 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 single room containing 4 (four) sheets of ice in which the sport of curling is played in the building located at 307 Westhill Blvd, Appleton, WI owned and operated by Club. 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.

The invalidity or unenforceability of any provision of this Release shall not affect the validity or enforceability of any other provision of this Release, which shall remain in full force and effect. If any provision contained in this Release is found to be unenforceable by reason of the extent, duration or scope thereof, or otherwise, then the court making such determination shall have the right to reduce such extent, duration, scope or other provision so that in its reduced form any such restriction shall thereafter be enforceable to the maximum extent permitted by law.

I acknowledge that I was given the opportunity to read this participant release and to consult with an attorney as to its significance. 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 by checking the above box titled “Adult Participant Release Acceptance.”

Payment Policy(Required)

I agree to the payment policy.

Payment of dues must be made before you step foot on the ice.

I understand there is no guarantee of a refund (full or partial) once ice making has begun. I understand there are start-up costs associated with ice-making the club must cover.
I understand there is no guarantee of a refund (full or partial) due to a suspension or termination of the actual on-ice curling season.
I understand once ice making has begun, the ACC Board will make a determination of refunds based on the financial sustainability of the club and member goodwill.
I understand membership dues are required to be paid before I participate in any on-ice league based activity. I may contact the Treasurer ([email protected]) to inquire about other payment arrangement
I understand that an additional team fee is required and due on the first night of my league. I understand that failure of the team to pay this fee can prevent participation in that league.

Payment Information

I will pay by:(Required)

Credit Card

Check

NOTICE: by selecting pay by check your payment of dues must be made before you step foot on the ice. Checks should be made payable to "Appleton Curling Club" and dropped in the treasure mailbox at the club.

Credit Card Processing Fee

Price: $0.00

There is a 2.9% + 30 cents for the processing of a credit card for this transaction. This fee is passed along to our members and guests for any transaction for which they elect this convenient form of payment.

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Payment Method

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

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Is Active Curler

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Home Curling Club

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Site ID

This is for WRH use only.

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Year at Home Curling Club

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Payment Status

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Calendar

New Account Setup

User Information

Parent/ Legal Guardian

Volunteer Hour Fee

Locker Fee

Optional Donation

Waiver & Emergency Contact Information

Payment Information

NOTICE: by selecting pay by check your payment of dues must be made before you step foot on the ice. Checks should be made payable to "Appleton Curling Club" and dropped in the treasure mailbox at the club.

Appleton Curling Club