Participation Waiver And Release Form

Participation Waiver And Release Form

The Purple Plunge - January 3, 2026 @ 1:30pm - 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 Penny Lane Pub, 150 Main St., Old Saybrook 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.
(Leave blank or type 0 if you will not be joining us)
Participant Signature*

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Date

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Date
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EMERGENCY CONTACT INFORMATION