New Canaan Winter Club
As a condition of participation in the New Canaan Winter Club’s 2018-2019 season and any of its skating programs, including, but not limited to, just general skating, it is necessary to obtain written consent for medical care and agreement that the New Canaan Winter Club will not be held responsible for any injury or damage sustained in connection with such participation. Accordingly, please complete and sign the form below.
Consent to Treat and Waiver of Liability - 2018-2019 Season
I, and all the listed family members below hereby consent to such participation and assume all risks and hazards that are incidental to participating in the skating programs of and general skating at the New Canaan Winter Club. We hereby exempt, waive, release, indemnify and agree to hold harmless, The New Canaan Winter Club, its coaches and all its other officials and representatives for any and all claims arising out of such participation, without limitation, claims for personal injury or loss of damage to property. We further agree and understand that all names listed below will only participate in skating programs in which we believe we are physically and psychologically prepared to participate within.

We also grant permission to any representative of the New Canaan Winter Club to obtain medical care and treatment from any physician, nurse, ambulance attendant, hospital, or medical clinic, should I or any family member listed below become ill or injured at any time while participating in any of the Club’s programs. We give permission to the New Canaan Winter Club to release medical information in connection with such medical treatment.

The undersigned agrees and intends that faxed signatures or other form of electronic transfer constitutes an original signatures.

Signature *
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Date *
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Family Name *
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Parent 1 Name
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Parent 2 Name
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Child 1 Name
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Child 1 Age
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Child 2 Name
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Child 2 Age
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Child 3 Name
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Child 3 Age
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Child 4 Name
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Child 4 Age
Your answer
*For families with 5 or more children, please submit an additional form.
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