We encourage all plungers to Pre-Register online as this will save you time at the registration tent on the day of the event and allow you to solicit donations easier. However if you'd like you can still print out a registration form. Plungers are able to solicit donations any way that they'd like, we encourage you setting up contests with your teammates. Sponsors are able to make donations through the online portal or through cash/check. If you're receiving a donation by cash/check you can issue a receipt to your sponsor.
If you plan on plunging with us we ask that you read the following Waiver and Release. All Plungers will need to sign a waiver before taking "The Plunge". Waivers will be available at the event, however, to save time you can print out, sign and bring the waiver with you.
In consideration of participating in the Rochester Polar Plunge, I represent that I understand the nature of the Rochester Polar Plunge event and that I and/or my minor child am qualified, in good health, and in proper physical condition to participate in such Activity. I further acknowledge that the Activity will be conducted over public roads and facilities open to the public during the Activity and upon which traffic hazards are to be expected. I acknowledge that if I and/or my minor child believe event conditions are unsafe, I and/or my minor child will immediately discontinue participation in the Activity.
I fully understand that the Rochester Polar Plunge involve risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the “releasees” names below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages I and/or my minor child incur as a result of my and/or minor child’s participation in the Activity.
I hereby release, discharge, and covenant not to sue Special Olympics New York, Inc., its respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and , if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the “Releasees” herin) from all liability claims, demands, losses, or damages on my account caused alleged to be caused whole or in part by the negligence of the “releasees” or otherwise including negligent rescue operations; and I further agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my and/or my minor child’s behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the releasees from any loss, liability, damage, or cost which any may incur as the result of such claim.
I have read this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, AND PARENTAL CONSENT AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it be a complete and unconditional release of all liability to the greatest extend allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.
First Name: ______________________________________ Last Name: _______________________________________________
Signature: ________________________________________________ Date: ____________________
Parent/Guardian Signature if under 18 years of age: _______________________________________________________________
Address:___________________________________________ City ___________________________ State_________ Zip_______
Email:________________________________________________ Phone # (______) _____________