Loading...

2024 SONC Caldwell County Polar Plunge

benefiting the Special Olympic Athletes of Caldwell County

February 24th, 2024

Granite Falls Recreation Department

Please COMPLETE Waiver for ALL Participating Jumpers.

For minors only, please select Minor.

For adults only, please select Adult. 

If both an adult and minor will be jumping/participating together, please select Adult and Minor.

SPECIAL OLYMPICS NORTH CAROLINA

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT AGREEMENT

IN CONSIDERATION of being permitted to participate in any way in any capacity for the 2024 Caldwell County Polar Plunge on February 24, 2024 or designated date, I, for myself, my personal representatives, assigns, heirs, and next of kin agree to the following:

1. ACKNOWLEDGMENT. I ACKNOWLEDGE, agree and represent that I understand the nature of Polar Plunge Activities and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if at any time I believe the conditions to be unsafe, I will immediately discontinue further participation in the Activity. I further agree to follow all safety rules and instructions, including, but not limited to, wearing required safety equipment and informing the instructor of conduct or a condition that might endanger myself or others.

2. ASSUMPTION OF THE RISK. I FULLY UNDERSTAND that: (a) Polar Plunge ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING, BUT NOT LIMITED TO, SCRAPES, BRUISES, BROKEN BONES, CONCUSSIONS, PERMANENT DISABILITY, PARALYSIS, AND DEATH; (b) these Activities involve risks and dangers of less severe injury, including, but not limited to scrapes, bruises, broken bones, and concussions; (c) these risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW; (d) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES that I incur as a result of my participation or that of the minor in the Activity.

3. WAIVER OF NEGLIGENCE. I HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the Special Olympics, Inc., Special Olympics North Carolina, its respective administrators, directors, agents, officers, members, volunteers, team members and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the RELEASEES herein) FROM ANY AND 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. This waiver of negligence applies to all phases of participation (i.e., warm-ups, use of equipment, use of facility, instruction, supervision, etc.).

4. INDEMNITY AGREEMENT. I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, REIMBURSE, DEFEND, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or costs which may be incurred as the result of such claim.

I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, 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 TO 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.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's T-Shirt Size
All attempts will be made to fulfill requested shirt size. Due to nature of ordering process, size requests can not be guaranteed. SHIRTS are ADULT Sizes Only.*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's T-Shirt Size
All attempts will be made to fulfill requested shirt size. Due to nature of ordering process, size requests can not be guaranteed. SHIRTS are ADULT Sizes Only.*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's T-Shirt Size
All attempts will be made to fulfill requested shirt size. Due to nature of ordering process, size requests can not be guaranteed. SHIRTS are ADULT Sizes Only.*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's T-Shirt Size
All attempts will be made to fulfill requested shirt size. Due to nature of ordering process, size requests can not be guaranteed. SHIRTS are ADULT Sizes Only.*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's T-Shirt Size
All attempts will be made to fulfill requested shirt size. Due to nature of ordering process, size requests can not be guaranteed. SHIRTS are ADULT Sizes Only.*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's T-Shirt Size
All attempts will be made to fulfill requested shirt size. Due to nature of ordering process, size requests can not be guaranteed. SHIRTS are ADULT Sizes Only.*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's T-Shirt Size
All attempts will be made to fulfill requested shirt size. Due to nature of ordering process, size requests can not be guaranteed. SHIRTS are ADULT Sizes Only.*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's T-Shirt Size
All attempts will be made to fulfill requested shirt size. Due to nature of ordering process, size requests can not be guaranteed. SHIRTS are ADULT Sizes Only.*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's T-Shirt Size
All attempts will be made to fulfill requested shirt size. Due to nature of ordering process, size requests can not be guaranteed. SHIRTS are ADULT Sizes Only.*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's T-Shirt Size
All attempts will be made to fulfill requested shirt size. Due to nature of ordering process, size requests can not be guaranteed. SHIRTS are ADULT Sizes Only.*
Parent or Guardian's Email Address

Email*
Check to receive additional information about the local Special Olympics Program in Caldwell County to include year-round activities and sponsorship opportunities.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Additional Information
Are you jumping as part of a Plunge Team or Cool School?*
No
Yes

If yes, Plunge Team or Cool School Name
Plunge Participant Payment *
Online, SONC Caldwell County Polar Plunge Classy Link
On-Site, Day of Event

AND I, THE MINOR’S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF Polar Plunge ACTIVITIES AND THE MINOR’S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE’S FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR’S ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR’S BEHALF MAKES A CLAIMS AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, REIMBURSE, DEFEND, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR ANY COSTS THAT MAY OCCUR AS A RESULT OF ANY SUCH CLAIM.



By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.

Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's T-Shirt Size
All attempts will be made to fulfill requested shirt size. Due to nature of ordering process, size requests can not be guaranteed. SHIRTS are ADULT Sizes Only.*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!