Long Island Polar Bears 26 Make-A-Wish ® Metro New York WAIVER

Make-A-Wish ® Metro New York

Long Beach Polar Bear Club 2026 Annual Polar Bear Splash
HOLD HARMLESS AGREEMENT & LIABILITY WAIVER
I the undersigned participant, understand and acknowledge that participation in the 2025 Long Beach Polar Bear Splash involves inherent risks, including but not limited to exposure to cold water, hypothermia, slippery surfaces, personal injury, and medical emergencies.

In consideration of being allowed to participate, I hereby release, waive, and hold harmless Make-A-Wish® Metro New York, the Long Beach Polar Bear Club, the City of Long Beach, their officers,directors, employees, volunteers, sponsors, and any other parties involved in the planning and execution of this event (collectively, the "Released Parties") from any and all claims, liabilities, damages, or expenses, including personal injury, medical emergencies, and property damage, arising
from or related to my participation in the event.

Assumption of Risk & Compliance
I understand and voluntarily assume all risks associated with participation. I further agree to comply with all federal, state, county, and local laws, including the City of Long Beach Charter and Code of Ordinances.
I acknowledge that diving into the water is strictly prohibited and agree to follow all event rules and safety instructions

Media Release
I understand that by participating in the Polar Bear Splash, my image, likeness, and voice may be recorded in photographs and/or video by Make-A-Wish and/or the Long Beach Polar Bear Club. I hereby grant Make-A-Wish and/or the Long Beach Polar Bear Club the unrestricted right to use, reproduce, distribute, and display such materials in any media, marketing, or promotional efforts related to the event, without compensation
Name*

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Address*

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CityState / Province

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Email*
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Age Agreement*

I am over 18As a parent or legal guardian, I am completing this form for my child who is under 18 years of age

Parental/ Guardian Consent (Required for Minor Participants)
If the participant is under 18 years old, a parent or legal guardian must complete the following:

I, the parent or legal guardian of the above-named minor, grant permission for my child to participate in the 2025 Long Beach Polar Bear Splash. I accept full responsibility for their actions and hereby agree to the terms of this Hold Harmless Agreement & Liability Waiver on their behalf
Full name of Parent/Guardian *

First NameLast Name
Signature*

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Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Minor Participant(s) Information *

First NameLast Name
Minor Participant(s) Information

First NameLast Name
Minor Participant(s) Information

First NameLast Name
Minor Participant(s) Information

First NameLast Name
Minor Participant(s) Information

First NameLast Name
Is this your first time participating in the Long Beach Polar Bear Splash

YesNo

Agreement & Acknowledgment
By signing this document, I certify that I have read, fully understand, and voluntarily agree to all terms outlined in this Hold Harmless Agreement & Liability Waiver
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Make-A-Wish ® Metro New York