2016 Pledge form here

2016 Penguin Plunge
January 1, 2016 ★ Panorama Park
12:30 - 3:00pm
ENTRY FORM
In consideration of your accepting this entry, I hereby, for myself, my heirs, executors and administrators,
waive and release any and all right and claim for damages I may have against the organizers holding this Event,
their agents, representatives, successors and assigns, for any and all injuries suffered by me at this Event.
PLEASE PRINT
Name:
Address:
(Surname)
Phone:
2016
Signature:
Age:
(Given Names)
Postal Code:
Email:
(If under 18, Parent or Guardian)
If not a first-timer, how often participated:
PLEDGE FORM
DEEP COVE
PANORAMA PARK
JANUARY 1st
12:30 - 3:00pm
PLUNGE PROMPTLY
Pledge Proceeds to benefit North Shore Rescue
Challenge your family, friends and colleagues to Plunge for Dollars.
Bring money and pledge form with you on New Year’s Day.
Please make cheques payable to North Shore Search & Rescue
DONORS NAME
DONORS ADDRESS
PAID PLEDGE $
at 2:00pm
Help raise funds for the North Shore Rescue
Obtain pledges for plunging this New Year’s Day
★ Free Plunge Registration
★ Food & Refreshments
★ Live Entertainment
★ Prizes for Costumes Judging at 1:30pm
For further information call: 604.838.2046
Prizes for
BEST
!
COSTUMES
TOTAL CHEQUES
TOTAL CASH
To be completed
by pledge collector
GRAND TOTAL
Pick up a pledge form at Deep Cove Outdoors and get a $10 Pledge to start you off!