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 signature.