Participant Registration-2018 Polar Bear Jump & 5K Race/Walk

Please complete the following Participant Registration & Waiver Form to sign-up for the 2018 Polar Bear Jump & 5K Race/Walk, January 27, 2018. After completing the Waiver Form, click Continue to proceed to registration payment ($30) via PayPal to complete your registration for the event.

Jumper/5K Race-Walker/Both *

I UNDERSTAND THAT A PARTICIPANT REGISTRATION FEE IS REQUIRED TO JUMP & 5K RACE/WALK

Participant Registration (Select to Register) *

Open this link to agree with Waiver Terms

Voluntary Participation Terms:I am voluntarily participating in the Event with full knowledge of the inherent risks, hazards and dangers involved and hereby assume and accept any and all risks of injury, paralysis or death, and agree to abide by all Polar Bear Plunge rules, regulations and guidelines. I hereby confirm that I am in good physical condition and do not suffer from any disabilities or physical conditions that place me at risk or otherwise should prohibit my participation in the Chippewa Lake Polar Bear Event.

Open this link to agree with Hold Harmless Terms

No Diving Policy: I agree that the Chippewa Lake Lions Club reserves the right to remove me from the water, at any time, for any reasonable cause. I agree that I will enter the water feet first. I understand that no diving is permitted.

No Pet Policy: I understand that the Chippewa Lake Lions Polar Bear Event does not allow pets. I agree by my initials below, not to bring my pet(s) to the Polar Bear Event.

I HAVE CAREFULLY, CLEARLY UNDERSTAND AND VOLUNTARY SIGN THIS WAIVER AND RELEASE AGREEMENT AND ACKNOWLEDGE THIS AGREEMENT BY COMPLETING ALL INFORMATION BELOW ..

Individuals 11 years of age or older may participate. A Parent or Legal Guardian must sign below after reading the following. Open this link to agree with the Waiver, Release and Indemnification Agreement

Photo Release Terms:I understand and agree and hereby give my consent to the Chippewa Lake Lions Club or any sponsor to use my photograph or likeness in any Chippewa Lake Lions Club or sponsor’s hard copy and/or electronic publications, including Websites. I release them from any expectation of confidentiality or compensation for myself and any undersigned minor and attest that I am the Parent or Guardian of said minor listed below.

* indicates required fields