Junior Release
PARTICIPANT RELEASE

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 and on behalf of the Minor
and the Minor’s estate, successors, heirs, beneficiaries, administrators, trustees, representatives, and
attorneys (collectively, “Releasors”) do hereby remise, release, acquit, and forever discharge (i)
Broomstones, Inc., a Massachusetts non-profit corporation (the “Club”); (ii) the United States
Curling Association, Inc. (“USCA”); (iii) the Grand National Curling Club (“GNCC”); (iv) the
respective successors and assigns or each of the Club, USCA, and GNCC; and (v) the respective
employees, officers, and directors, but only while acting in their capacity as such, of each of the
Club, USCA, and GNCC (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 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 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 the single room containing four sheets of ice in which the sport of
curling is played in the building located at 1 Curling Lane, Wayland, MA 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.

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/

In consideration of the Minor being permitted to participate in curling draws, matches,
bonspiels, and other athletic and non-athletic events which take place at the Club, whether in or
outside of the Ice House (“Events”), I, the undersigned, for and on behalf of the Releasors, hereby
grant permission and a perpetual, royalty-free, worldwide, sublicensable, and non-exclusive license

Youth 667628_2
to the Releasees to record, store, display, reproduce, copy, publish, perform, transmit, broadcast,
distribute, sell, and otherwise use (“Permitted Uses”) at any time and in any type of media or manner
the Minor’s name, voice, image, likeness, actions, and “original works of authorship” (as that term is
used in section 102 of the Copyright Law, Title 17 of the United States Code) appearing, seen, or
heard in the Events. In connection with the Minor’s participation in Events and the Permitted Uses, I,
the undersigned, for and on behalf of the Releasors, hereby release any and all claims against the
Releasees relating to, or arising out of, ownership, copyright, and rights of privacy and/or publicity.

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.

Electronic Signature *
By signing I agree to the release above
Your answer
Name of Minor *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Broomstones Inc..