Caroline County Polar Bear Plunge Participant Packet Lake Land'or Beach 9:00am - 12:30pm - February 6th, 2021

Caroline County
Polar Bear Plunge Participant Packet
         February 6th, 2021
        Lake Land’or Beach
         9:00am – 12:30pm

   Registration and Event Information
 Sponsored by: Ladysmith Ruritan Club

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Event History and Purpose

In 2006, Wright’s Chapel United Methodist Church hosted its first Polar Bear
Plunge to raise money for local families in need of assistance with heating their
homes through the winter season. The event grew in popularity and numbers and
more churches began to participate to raise funds for their specific charity needs.
Since that time, hundreds of plungers have gotten cold so that money could be
raised to help those in the local community needing assistance. Since the
Ladysmith Ruritan Club took over the sponsorship of the event three years ago,
over $56,000 has been raised for the local community.

In 2015, the Wright’s Chapel Polar Bear Plunge changed its name to reflect a
change in operations. The Caroline County Polar Bear Plunge will continue this
year (2020) with the support of numerous area churches and non-profit
organizations. The Ladysmith Ruritan Club will serve as the main event organizer
and will have the support of several organizations and churches: Wright’s Chapel
UMC, St. Mary of the Annunciation Catholic Church, Rehoboth UMC, the
Caroline YMCA, Caroline’s Promise, Ladysmith Volunteer Fire Company,
Bowling Green Baptist Church, A Tail To Be Told, and Young Life.
Representatives from these organizations are currently meeting to plan and
coordinate the efforts for the Plunge. They are working hard to ensure the Plunge
continues to grow in popularity and fundraising efforts.

If any local church or non-profit organization is interested in joining the
committee, please contact Jeff Black (540-424-0264 or jsblack231@gmail.com) by
December 1st, 2020.

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YES! I want to be a plunger!
By volunteering to be a plunger, I agree to raise money for local assistance in Caroline County. I
understand that if I raise at least $100 in donations by January 1, 2021, that I will receive a free
Caroline County Polar Bear Plunge T-shirt. If I do not raise donations, but still want to
participate in the event, I will be required to pay a $25.00 registration fee on the day of the event.

I will read, understand, and sign the waiver on the back of the registration form.

Name: _________________________________________________________

Address: _______________________________________________________

City: _______________________ State: _________ Zip: ______________

Phone: _________________________ Email: _________________________
I am affiliated with the following participating organization:

_______ Wright’s Chapel UMC                            _______ Ladysmith Volunteer Fire Company

_______ Rehoboth UMC                                   _______ Caroline’s Promise

_______ Ladysmith Ruritan Club                         _______ Bowling Green Baptist Church

_______ St. Mary’s Catholic Church                     _______ A Tail To Be Told

_______ Caroline YMCA                                  _______ Young Life

Any organization must pay a $100 registration fee to the Ladysmith Ruritan Club to be a
designated participating organization.

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Caroline County Polar Bear Plunge Committee (“Committee”) and Lake Land’Or
  POA, Inc. (“POA”) Release and Waiver of Liability, Assumption of Risk, and
           Indemnity, and Parental Consent Agreement (“Agreement”)

In consideration of participating in the Polar Bear Plunge (“Plunge”) I represent that I understand the
nature of the Plunge events and that I and/or my minor child am qualified, in good health, and in proper
physical condition to participate in such event. I acknowledge that if I and/or my minor child believe
event conditions are unsafe, I and/or my minor child will immediately discontinue participation in the
event.

I fully understand that Plunge events involve risks of serious bodily injury, including permanent
disability, paralysis and death, which may be caused by my own actions, or inactions, those of others
participating in the event, the conditions in which the event takes place, or the negligence of the
“releases” named below; and that there may be other risks either not known by me or not readily
foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs,
and damages I and/or my minor child incur as a result of my and/or my minor child’s participation in the
event.

I hereby release, discharge, and covenant not to sue the Committee or the POA, its administrators,
directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and if
applicable, owners, and lessors of premises on which the event takes place, (each considered one of the
“Releasers” herein) from all liability, claims, demands, losses, or damages on my account caused or
alleged to be caused in whole or in part by the negligence of the Releasers or otherwise, including
negligent rescue operations; and I further agree that if, despite this release, waiver of liability, and
assumption of risk, I or anyone on my and/or my minor child’s behalf, makes a claim against any of the
Releasers, I will indemnify, save, and hold harmless each of the Releasers from any loss, liability,
damage, or cost which any may incur as the result of such claim.

I have read this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND
INDEMNITY AGREEMENT, AND PARENTAL CONSENT AGREEMENT, understand that I have
given up substantial rights by signing it and have signed it freely and without any inducement or
assurance of any nature and intend it be a complete and unconditional release of all liability to the greatest
extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance,
notwithstanding, shall continue in full force and effect.

_________________________________________                   _______________________________________
       Printed Name of Participant                                 Signature of Participant (18 or over)

Date: _____________________                ____________________________________________________
                                           Signature of Parent/Legal Guardian (if participant under age 18)

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2021 Caroline County Polar Bear Plunge – sponsored by Ladysmith Ruritan Club
                        Plunger Fundraiser Spreadsheet

Plunger Name: ______________________________________________________

Designated Organization to receive funds: ________________________________

    *All checks should be made out directly to your designated organization.

               Donor Name                       Amount        Check/       Date
                                                               Cash       Received

                   Total Amount Collected: ________________
 Turn in all funds to your organization’s financial representative by February 5th

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Donor Name       Amount   Check/    Date
                           Cash    Received

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IMPORTANT DATES / DEADLINES

1) The Plunge is scheduled for February 6, 2021 with events and music
   beginning at 9:30am. If inclement weather presents itself and the roads are
   too dangerous for travel, the Plunge will be moved to February 13, 2021 at
   the same time of day. Due to Covid-19 restrictions, the plunge schedule will
   follow with state guidelines regarding the gathering of people and events.
   This is subject to change quickly, but organizations will be notified via email
   and information will be posted on the Ladysmith Ruritan Club webpage.
2) Due to Covid-19, money collection WILL NOT take place on the day of the
   event. All organizations have an online presence for funds and must
   document all donations (online, cash, check) through the online giving
   format. Official Plunge totals will be tallied on Friday, Feburary 5th at
   5:00pm.
3) Plungers must have at least $100 in donations turned in to their participating
   organizations by January 1, 2021 in order to receive a free T-shirt. All
   organizations/participants must fill out a Google Form Survey (to be
   sent in December 2020) to document the plungers that will receive
   tshirts (earned or paid for by the organization). Texts, pictures,
   messages, emails, etc. will not be an accepted form of communication for
   tshirt orders.
4) Any business wishing to donate $100 or more will be included in any
   advertising for the Plunge. Donations need to be made by January 1st, 2021
   in order to meet advertising deadlines. Businesses will also be allowed to
   advertise with signage at the Plunge.
5) Businesses wishing to donate coupons and/or items for prizes or raffle must
   submit them by January 6, 2021.
6) Non-profits and churches wishing to register their organization must submit
   their information and payment of $100 by December 1st, 2020. Checks
   should be made payable to Ladysmith Ruritan Club. Please include Polar
   Bear Plunge on the memo of the check.

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Plunge Participant Checklist
Prior to the Plunge…
   In order to receive a t-shirt, turn in your name and $100
    donation list (donor names) to your designated
    organization/church by January 1st, 2021.
   Track your donations on the provided spreadsheet and/or
    online.

Plunge Day
   Bring a towel and warm change of clothes for after the
    plunge.
   Have a “spotter/buddy” on the beach to watch your entry
    and exit from the lake.
   Dress up for the costume contest! Prizes will be given to
    the organization that you plunge for! Fill out the costume
    contest form after you turn in your money to your
    respective organization.

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