WHEN: Saturday May 3, 2025
LOCATION: LUCIEN LAKE REGIONAL PARK BEACH FRONT (CHECK IN AT BETHANY)
CHECK IN: 12PM AT BETHANY PIONEER VILLAGE SWIM: 2PM AWARDS: 3:30PM
AFTER: Join us for Chili Cookoff Contest
All monies raised will be put towards renovations of our tub room.
Participant Registration Form
*If registering as a team, please enter all family members in name field.
Name(s): Number of Particants: Address: City: Postal Code: Phone: Email Address:
Emergency Contact:
Name:
Phone:
Participant(s) are OVER 18 years old
A participant is UNDER 18 years old
Adult Waiver
**The waiver below will be included in your participant package emailed to you after registration is complete.
Youth Waiver
**The waiver will also be emailed with your participant package for a parent or legal guardian to sign.**
Anyone over 10 and under the age of 18 must be accompanied by their parent or guardian
If any participant is under 18 years of age at the time of registration, a parent or legal guardian must
completely review the Waiver and Release, understands and consents to its terms, and
authorizes participation. Participants must be over the age of 10 to register.
Parent/Guardian Details:
Name: Phone: Email Address: Age of Youth (youngest if registering more than one):
LIABILITY AND WAIVER STATEMENT
In consideration of being allowed to participate, individuals release the
organizers, its representatives, leaders, email senders, volunteers and
members of this fundraising event from all liability in respect of any personal
injury suffered, any damage or loss of personal property, which may arise
out of participation in this fundraising outdoor activity.
I further acknowledge and understand that participation in this outdoor activity carries with
it inherent risks including, but not limited to, the risk of injury.
It is the responsibility of each participant of this event to familiarize themselves with the risks
of swimming in cold water and including but not limited to other weather conditions, to
weigh those risks against the advantages, and to decide whether or not to participate.
The organizers of this event; the representatives; leaders and members cannot and will not
assume liability in respect of any of these risks, dangers, hazards and liabilities.
Participants further acknowledge that it is their responsibility to ensure that they carry
adequate medical, extended health, dental and accident insurance coverage, as well as
protection for personal possessions.
It is the participant’s individual responsibility to verify that they are in good health and are
physically capable of carrying out the outdoor activities or waiting in spring weather
conditions for the official start of the Polar Bear Icebreaker Swim.
I hereby assume all of the risks of participating in and/or volunteering at this event.
*Please note ALL participants must each have a waiver filled out and signed by them or their parent/legal guardian if under 18.
Please check this box to confirm you understood and accept the above waiver.
Additional Comments or Questions:
Register for the Event
Your registration package will be sent to the email provided.