If you would like to register for the St. John the Baptist - Gildehaus Polar Plunge on January 8th, 2022, please complete the following form...or just show up!

Only ages 10 and up may participate in the Polar Plunge...all are welcome, though!  T-shirts are available for $20 for anyone...whether you "plunge" or not!

First Name of participating adult or participating minor.
Last name of participating adult or participating minor.
Address Line 1  *
Address Line 2
City  *
State or Region  *
Country
Zip  *
Address of participant.
Birth date of participant
Name of an emergency contact for the participant.
Phone number of emergency contact.

Only one participant per form, please. Please note...only children 10 and older can participate in this event.

If you would like additional t-shirts (at $20 each), please let us know here; or, if there is anything else you would like us to know.
If you wish to purchase a t-shirt, please let us know here.

Registration Fee paid and t-shirts purchased on day of event, by check or cash only. Registration fee and t-shirts may be pre-paid via credit/debit card or ACH (checking/savings account) withdrawal at Our Sunday Visitor: https://www.osvhub.com/sjg-parish/funds/polar-plunge-2022 in Confirmation E-mail). Event Registration Fee: $10 per person; T-Shirt(s) @ $20 each.

I agree to this Consent to Photo Release..
Agreement required to register for the event. A parent or guardian must accept this registration if a minor under the age of 18 is registered for the event.
I agree to the terms and conditions of the Assumption of Risk, Release and Waiver of Liability.
Agreement required to register for the event. A parent or guardian must be an adult on this registration if any minors under the age of 18 are registered for the event.
Name of minor(s) who is/are participating in this event, if applicable.
Name of adult/guardian who is agreeing to these Terms and Conditions on behalf of the minor, if applicable.
If an adult is agreeing to these terms on behalf of a minor, the relationship of the adult to the minor.
Name of adult who is agreeing to these Terms and Conditions.