Participation Waiver And Release Form

Participation Waiver And Release Form

The Purple Plunge - January 4, 2025 @ 1:00pm - Soundview Beach, Old Lyme, CT
The event sponsor, Desmond's Army Animal Law Advocates, will not be responsible for bodily injury, property damage,
or COVID/illness that may occur as a result of this event.

Children 18 and under must be accompanied by an adult.

PLEASE SUBMIT YOUR COMPLETED FORM BY 12/23/24
Participant Name*

First NameLast Name
DOB*

MonthDayYear
Date
Email
example@example.com
Phone Number*
Please enter a valid phone number.
EMERGENCY CONTACT INFORMATION
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
After the plunge, we will be going to a nearby restaurant for a cocktail and/or a bite to eat. We invite you to come along. Please let us know if you will join us and how many people are in your party. This will help us choose a restaurant that can accommodate us all.
(Leave blank or type 0 if you will not be joining us)
Participant Signature*

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Date

MonthDayYear
Date
Should be Empty:

EMERGENCY CONTACT INFORMATION