The 12 forms of Winter –
Winter Splash Dip & Donate
Donation form example
Join us for a cold-water charity event. Dip and donate if you can!
Company
This field is for validation purposes and should be left unchanged.
Name
(Required)
First
Last
Email
(Required)
Enter Email
Confirm Email
Donation Amount
(Required)
10 USD
50 USD
250 USD
Other amount
Choose how much you would like to donate.
Other Amount
Total
Winter Splash Participant Liability Waiver & Consent
(Required)
Please read carefully. By submitting this form, you acknowledge and agree to the following terms.
I, the undersigned participant, voluntarily choose to participate in the Cold-Water Charity Dip (the “Event”), which involves entering cold or near-freezing water and may include strenuous physical activity. I understand that participation in the Event carries inherent risks, including but not limited to:
Cold shock response
Hypothermia
Slips, trips, or falls
Muscle strain or injury
Other unforeseen hazards associated with outdoor winter activities
I certify that I am physically capable of participating in the Event and that I have no medical conditions that would make such participation unsafe. I understand that it is my responsibility to consult with a physician regarding any concerns about my health or ability to safely take part in the Event.
I acknowledge that the Event organizers, sponsors, volunteers, and venue hosts (collectively, the “Organizers”) are not responsible for any personal injury, illness, accident, loss, or damage to myself or my property that may occur before, during, or after the Event.
By participating, I agree to:
Assume all risks associated with the Event, whether known or unknown.
Release, waive, and discharge the Organizers from any and all liability arising from my participation.
Follow all safety instructions provided by Event staff and volunteers.
Notify Event staff immediately if I experience any concerning symptoms before or during the Event.
Provide accurate and truthful information on this registration form.
I understand that photographs, video recordings, and other media may be taken during the Event. I grant permission for the Organizers to use my likeness, name, and statements for promotional, marketing, and fundraising purposes, without compensation, unless I opt out where provided.
I also consent to the collection and use of my personal information for Event logistics, communications, and safety purposes, in accordance with applicable privacy laws.
I confirm that I am at least 18 years of age, or that I have obtained the consent of a parent or legal guardian who has signed below if I am a minor.
By checking the box below and submitting this form, I acknowledge that I have read, understood, and agree to all terms of this Participant Waiver & Consent.
I agree to the liability waiver and release of claims.
Credit Card
