Registration
Date: February 26, 2023
Time: 12:00 PM - 3:00 PM (Check In starts at 12:00 PM & Plunge approx. 2:00 PM)
Location: Westbrook Town Beach (West Beach), Seaside Ave, Westbrook, CT. 06498
Contact: Ken Brajczewski at (860) 575-3253 or WestbrookCTAthleticBoosters@gmail.com
Cost:  $25 per Registered plunger
Prizes: Top 3 fundraisers.
              1st:  $100 Amazon Gift Card
              2nd:  $75 Amazon Gift Card
              3rd:  $50 Amazon Gift Card

NO PARTICIPANT INFORMATION FROM THIS FORM WILL BE SHARED 

All participants must complete the Registration Form and check the Waiver section at the bottom of this form, to participate.

Participants under 18 years of age must  fill out this form and enter the name and email of your parent or guardian at the bottom of this form, following the waiver.

Registration Payment

$25.00 per registered participant payment can be made via Venmo, Check or Cash
  • Check
    Make Check payable to: Westbrook Athletic Boosters
    Mail to: Westbrook Athletic Boosters, 156 McVeagh Rd, Westbrook, CT. 06498
    In memo, enter 2023 Plunge
    Include note in envelope of who the registration is for from the online registration(s)
    If sending for more than one participant, note in memo who the payment is for
  • Cash
    Bring cash to event registration table the day of the event or in person to the registration table (least preferred method)
  • Venmo
    Venmo registration amount to @WestbrookCT-Athletic-Boosters or click HERE for QR code
    Include note  of who the registration is for from the online registration(s)
    If sending for more than one participant, note in memo who the payment is for
    Venmo sharing is turned off for the Boosters so your name will not be seen 
Fundraising

The Freezin for the Season plunge is a fundraising event.  All funds raised will be used for the Student-Athletes from the Westbrook Middle and High Schools.  We encourage each participant to get donations from family, friends and neighbors and in return, you will be chilling in the Sound on February 26th!  We are looking to award prizes for top fundraisers but haven't determined the prizes at this point.

Please print out the following fundraising sheet and document all donations to your plunge.  Collect the money and bring with you the day of the plunge and drop off at the registration booth.  Last year we raised over $7000 and we are hoping this year we can top it.

Link to Pledge form --> Plunge Donation Form
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Payment Method to be used (Must select one) *
Date of Birth of Participant *
MM
/
DD
/
YYYY
Phone # (Optional)
Address *
Town *
State *
Zip code *
Would you like to help with set up and/or break down of the event? *
Required
Comments or Questions

Waiver & Release of Liability, Assumption of Risk and Indemnification Agreement

In consideration of participating in the Freezin for the Season Plunge (“Event”),

(1)     I represent that I understand the nature of the Event and that I and/or my minor child am qualified, in good health, and in proper physical condition to participate in such Event.

(2)     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 Event.  

(3)     I fully understand that Event involves risk 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” named below; and that there may be other risks either not known to me or not readily foreseeable at this time.

(4)     I agree not to jump into the water headfirst.

(5)     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 my minor child’s participation in the Event.  

(6)     I hereby release, discharge, and covenant not to sue Westbrook Athletics Boosters, their officers, volunteers,  other participants, any sponsors, advertisers, owners and lessors of premises on which the Activity takes place, (each considered one of the ‘RELEASEES’ herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the “releasees” or otherwise, including negligent rescue operations

(7)     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.

(8)     I authorize Westbrook Athletic Boosters and its and all persons acting under its authority to promote the Event to use written statements, photos, videotapes and recordings of, about or obtained by me or my minor child or ward. I waive any right to inspect or approve the finished product or the advertising or other copy, which may be used in connection or the use to which it may be applied. I release and discharge Westbrook Athletic Boosters, and all persons acting under its authority, from any liability for any violation of any personal or property rights which I might have in connection with such materials.

(9)     If registering myself, I hereby represent that I am over the age of 18. If registering a child under the age of 18 or a ward, I hereby represent that I am the parent or legal guardian of such person and have the legal authority to enter into this agreement on their behalf.

 

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 extent 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.


*
Required
If Participant is under age 18 on February 26, 2023, Please enter parent or legal guardians Full Name and Email address here
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy