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Individual Registration
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Individual Plunger Registration Form

To register as an individual plunger for the 2011 Polar Plunge, please fill in the form below.

The minimum donation for a non-student plunger is $50.00

The student plunger minimum donation is $30.00

There are awards for most money raised by an individual and for best costume.

                                 

First Name            Last Name  

Address          

City                                 State   

Zip Code                 Phone            

E-Mail            

I am A Student           School Name   

First Time Plunger               Over 18 

Students can plunge for a $30.00 entrance donation. Please have a student ID to show at check-in.

                                                                    

 

All plungers must sign a waiver/release form prior to the Plunge. You can print a waiver form (see link below), sign it and bring it to the registration tent. If you 18 and under, please have a parent or guardian sign the form also.

 

2011 Plunge Waiver Form