Hope House Endurance Team

Polar Plunge

HOLD HARMLESS/PERMISSION REQUEST

By filling out this online registration form I request permission to participate in the Hope House Endurance Team Polar Plunge sponsored by Ministry for Hope, Inc. dba Hope House Ministries in Port Jefferson, New York.  I understand that my participation will involve active physical participation, which includes a potential risk of personal injury.  I make this request with full knowledge of the possibility of personal injury that may result from participating in this event.

I agree to hold Hope House Ministries, and their agents and personnel, harmless from any and all claims, suits, and/or injury that I may suffer, and which may arise as a result of my participation in the Polar Plunge.

I agree to follow the rules established by the instructors, and to exercise reasonable care while participating in the Polar Plunge Event.  I understand that if I fail to follow the instructor’s rules and regulations or if I fail to exercise reasonable care, I can be removed from the event.

By clicking the below "Submit" button I am executing this release, I certify that I have read this release in its entirety, understand all of its terms and have had any questions regarding the release, or its effect satisfactorily answered. I sign this release freely and voluntarily.

** Once you click the "Submit" button you will receive a Thank You message that includes a Donate button. Your donation is much appreciated!