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REGISTRATION FORM FOR THE 2017-2018 CURLING SEASON

STEP 1 OF 3: Enter registration details

Note that all required fields are marked with **


Enter Contact Details:

First Name: **
Middle Name:
Last Name: **
Gender: **
Address: **

City: **
Province/State: **
Postal/Zip Code: **
Country: **
Home Phone: **
Mobile Phone:
Work Phone:
Ext.:
Member Since: **
Years Curling Experience: **
Email:

Please enter your email address here. Email is the primary method used to communicate with our members and is only used for that purpose. If you do not have an email address please leave this field blank.

Re-enter Email:
Emergency Contact (If youth, enter parent): **
Emergency Contact Phone Number: **
Date of Birth: **
Youth members are required to enter their full date of birth including the year. If you want to take advantage of any available age discounts you must enter your full date of birth including the year.

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 numbers will be listed in the membership directory and/or website for general member use. This information is intended for the sole use of Club and will not be shared outside the Club.


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.

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.”


Registration Selection: **

Select the membership type first by checking on the approproiate round checkbox.

Check the square checkbox(es) next to each league you wish to play in

If you know your team members, type their names in the boxes.  If you have empty spot(s) or wish to be placed on a team, type TBD in the other boxes.

Skips - Please email the League Manager to ensure everything if correct with your team or if you are in need of additional members to fill out your team.

If you are playing a specific night but do not yet have a team, please email the League Manager so they know you are looking for a team. 

This will help eliminate confusion and ensure the League Managers can set up the league properly.

League Curling

Single membership cost $313.00 using PayPal or $305.00 for cash or check. See below for first year, couples, high school and student discounts. 

Sunday Night 5 Year and Under

Notes for Convenor (Five Year and Under League): 
Skip: ** 
Vice-Skip: ** 
Second: ** 
Lead: ** 
Alternate: 

Monday Night Open

Notes for Convenor (Monday Night Open): 
Skip: ** 
Vice-Skip: ** 
Second: ** 
Lead: ** 
Alternate: 

Tuesday Night Women / Open

Notes for Convenor (Tuesday Night Women and Open): 
Skip: ** 
Vice-Skip: ** 
Second: ** 
Lead: ** 
Alternate: 

Wednesday Night Open

Notes for Convenor (Wednesday Open): 
Skip: ** 
Vice-Skip: ** 
Second: ** 
Lead: ** 
Alternate: 

Thursday Night Men

Notes for Convenor (Thursday Night Men): 
Skip: ** 
Vice-Skip: ** 
Second: ** 
Lead: ** 
Alternate: 

High School

Notes for Convenor (High School): 

Special Membership Options

Social (club activities/events – Social members are allowed to curl up to three time per season) Cost $85.00 cash or check.


Additional Registration Options

Locker Fee $20.00. 

***If you choose to use PayPal to pay your dues please check this box*** This is a $8.00 charge.

First Year Member!***If you choose to use PayPal to pay your dues please check this box*** This is a $4.00 charge.

Check this if you did not participate in the ten hour volunteer option last season and are required to pay the $50.00 assessment. Not required for first year members. Does not apply to second year membership fees.


Registration Discount Options

50% First Year Discount. Final cost for membership is $152.50

Married couples or domestic partners at same address. Final cost per person for membership is $235.00. First year couples please use the 50% discount above for $152.50 per person. There is no extra discount for first year couples.

Select this if you are a High School Curler. If you are a club member child, DO NOT SELECT THIS. Only select the HS Child discount. Final cost is $45.00

For students that are children of ACC members curling in the Tuesday High School League. Final cost after discount is $20.00.

Discount for full time students ages 18-25. Final cost is $85.00 for membership. 

Returning Curler Discount (no membership in the previous 3 years. Adult members only). Final cost is $240.00 for membership. 



Profile / Other Information:

Occupation **   


Registration Accuracy Confirmation: **

I hereby confirm that the information I have entered on this form is correct and true. I understand that if I have intentionally entered false information in this form to receive discounts that do not apply to me there will be a $25 administration charge on top of the outstanding membership dues owed.

I understand that membership dues are due on December 15th, and that there is a $50 late fee for dues paid after that date.

I understand that for the protection of all club members video surveillance is in use on the premises.

I understand that no alcohol carry-ins are allowed on the premises.



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