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

Make-A-Wish ® Metro New York

Long Beach Polar Bear Club 2026 Annual Polar Bear Splash
HOLD HARMLESS AGREEMENT & LIABILITY WAIVER
IMPORTANT — REQUIRED FOR PARTICIPATION
You must present this signed waiver at check-in.
You may show the signed waiver on your phone or
Bring a printed copy with you on event day.
Acknowledgment of Risk
I understand that participation in the 2026 Long Beach Polar Bear Splash involves inherent risks, including but not limited to:

Exposure to cold water
Hypothermia
Slippery or uneven surfaces
Physical injury
Medical emergencies
I voluntarily choose to participate with full knowledge of these risks.

Release, Waiver & Hold Harmless Agreement
In consideration of being permitted to participate, I release, waive, and agree to hold harmless Make-A-Wish® Metro New York, the Long Beach Polar Bear Club, the City of Long Beach, and all related officers, directors, employees, volunteers, sponsors, and event partners (collectively, the “Released Parties”) from any and all claims, liabilities, damages, losses, or expenses of any kind, including personal injury, medical emergencies, or property damage, arising out of or related to my participation in this event.

Assumption of Risk & Rules Compliance
I knowingly and voluntarily assume all risks associated with participation.
I agree to comply with all event rules, safety instructions, and all applicable federal, state, county, and local laws, including the City of Long Beach Charter and Code of Ordinances.

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.
I acknowledge that diving into the water is strictly prohibited and agree to follow all event rules and safety instructions

By checking the box below and typing my full legal name, I acknowledge that I have read and fully understand this Hold Harmless Agreement & Liability Waiver. I agree that my typed name constitutes my electronic signature, that this agreement is legally binding, and that it is enforceable to the fullest extent permitted by law.
I have read and agreed to the Hold Harmless Agreement & Liability Waiver*

I agree
Full Legal Name*

First NameLast Name
Signature*

Clear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com

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)
I am the parent or legal guardian of the minor participant listed below. I have read and fully understand the Hold Harmless Agreement & Liability Waiver above and acknowledge the inherent risks associated with participation in the 2026 Long Beach Polar Bear Splash, including but not limited to cold water exposure, hypothermia, physical injury, and medical emergencies.

On behalf of myself and the minor participant, I hereby consent to the minor’s participation in the event and agree to release, waive, and hold harmless Make-A-Wish® Metro New York, the Long Beach Polar Bear Club, the City of Long Beach, and all related officers, directors, employees, volunteers, sponsors, and event partners from any and all claims, liabilities, damages, losses, or expenses arising out of or related to the minor’s participation, to the fullest extent permitted by law.
I certify that I am the legal parent or guardian of the minor participant and that I have the legal authority to execute this agreement on the minor’s behalf. By checking the box below and typing my full legal name, I acknowledge that this constitutes my electronic signature and that this agreement is legally binding.*

I agree
Full Legal Name of Parent/Guardian *

First NameLast Name
Signature*

Clear
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 typing my full legal name, I certify that I have read, fully understand, and voluntarily agree to all terms outlined in this Hold Harmless Agreement & Liability Waiver and Media Release.
Full Legal Name *
Signature*

Clear
Should be Empty:

Make-A-Wish ® Metro New York

HOLD HARMLESS AGREEMENT & LIABILITY WAIVER
IMPORTANT — REQUIRED FOR PARTICIPATION
You must present this signed waiver at check-in.
You may show the signed waiver on your phone or
Bring a printed copy with you on event day.

I acknowledge that diving into the water is strictly prohibited and agree to follow all event rules and safety instructions

Parental/ Guardian Consent (Required for Minor Participants)

Make-A-Wish ® Metro New York

HOLD HARMLESS AGREEMENT & LIABILITY WAIVERIMPORTANT — REQUIRED FOR PARTICIPATIONYou must present this signed waiver at check-in.You may show the signed waiver on your phone orBring a printed copy with you on event day.

I acknowledge that diving into the water is strictly prohibited and agree to follow all event rules and safety instructions

Parental/ Guardian Consent (Required for Minor Participants)

HOLD HARMLESS AGREEMENT & LIABILITY WAIVER
IMPORTANT — REQUIRED FOR PARTICIPATION
You must present this signed waiver at check-in.
You may show the signed waiver on your phone or
Bring a printed copy with you on event day.