Liability Waiver and Entry Form
LIABILITY WAIVER FOR
|PHONE NUMBER ________________________|
|DATE OF BIRTH __________________________|
|WARNING: COLD WATER SWIMMING CAN PRODUCE INJURY AND/OR DEATH
I, ____________________________, have voluntarily elected to participate in the Page-Lake Powell Polar Bear Plunge. I fully understand that this involves jumping or running into the cold water of Lake Powell under January winter weather conditions and that there are health and safety risks associated with this type of activity. I, therefore, assume all risk of injury and/or death associated with this event and I will not hold the Page-Lake Powell Polar Bear Club or any sponsors liable for any circumstance related to this event.
I hereby confirm that I am in good physical condition and do not suffer from any disabilities or physical conditions that places me at risk or otherwise should prohibit my participation in the Page-Lake Powell Polar Bear Plunge.Furthermore, in consideration of my participation in this program, I myself, my heirs and assigns, release the Page-Lake Powell Polar Bear Club, their sponsors and any volunteers, from any and all claims, actions, demands, expenses liabilities (including reasonable attorney's fees) and negligence made or brought by myself or said minor or by anyone on behalf of said minor, as a result of participation in the Event.
I, for myself or on behalf of said minor, further agree not to sue the any of the officers, agents, affiliates, employees, contractors, or volunteers, as a result of any injury, paralysis or death that might be suffered in connection with participation in the Event.
I hereby affirm that I fully understand the preceding paragraphs and volunteer to participate at my own risk.
Signature of Parent or Guardian: ____________________________________________________
Participants are expected to immerse their entire body and head without wearing wetsuits, drysuits or other protective clothing. Footwear is recommended due to safety concerns and the fact that numb feet may not feel objects in the water.
ANYONE WITH HEART PROBLEMS - JUST WATCH!
DO NOT DRINK - ALCOHOL DOES NOT WARM YOU UP - IT ACCELERATES HYPOTHERMIA.
DO NOT STAY IN THE WATER LONGER THAN 15 MINUTES.
BODY HEAT IS LOST 25 TIMES FASTER IN WATER THAN IN AIR.
DO NOT REMOVE YOUR OUTER CLOTHING UNTIL SWIM TIME.