It`s our 13th Annual Polar Pout Plunge!

It’s our 13th Annual
Polar Pout Plunge!
INDIVIDUAL REGISTRATION FORM
Member of: TEAM _______________________________
Last Name______________________________________
www.facebook.com/poutplunge
First Name______________________________________
City___________________________________________
State _______________ Zip Code __________________
Phone (_____) __________________________________
E-mail _________________________________________
Are you jumping today? ___________________________
Sex
M
Age
•Raise at least $50 to jump and earn prizes!
•The more you raise, the better the prizes!
•For every $500 raised, you get a Moondance
•We can help you raise money! Contact the
For myself and on behalf of my minor children and/or legal I hereby
for myself, my heirs, executors, personal representatives or anyone
else who might claim on my behalf, covenant not to sue, and waive,
release and discharge the Walker Area Community Center and any
other organization associated with the event, including local governments, service clubs, volunteers and any and all sponsors including the agents, employees, assigns or anyone acting on behalf
of any of them, from any and all claims or liability for death, personal
injury, or property damage, of any kind or nature, arising out of, or
in the course of, my participation in this event, whether foreseen
or unforeseen, known or unknown. I further give full permission to
this event and any organization conducting or associated with this
event, and any agents authorized by them, to use any photographs,
videotapes, motion pictures, recording, or any other record of this
event for any lawful purpose.
_____________________________________________
Signature
Date
I am legal guardian of and represent the following
minor children who may participate in the plunge:
_____________________________________________
Signature
Date
$50
or
$100
or
$250
•BRING THIS FORM ON PLUNGE DAY!
or
or
or
or
or
BONUS! For every $500
raised, you get a
free Moondance ticket!
Get the best view with our VIP Pass!
16
20
VERY
You can be INSIDE the plunge area
IMPORTANT
POUTER!
I WILL NOT JUMP HEADFIRST!
PLUNGER PRIZES: You pick, limit one garment per plunger.
WACC for more details: 218-547-1853
VIP SEATING: $10 or 3/$20
Consent Form
Earn great prizes including Moondance tickets!
Ticket in addition to a Plunge garment.
F
Bring this form to registration filled out and signed.
SATURDAY, FEBRUARY 20th, 2016
RAISE MONEY FOR YOUR JUMP...
Address________________________________________
e
polar pout plung
SS
VIP/ PRESS PA
!
13th Annual
, 2016, 2:00 PM
FEBRUARY 20th
tPlunge.com
www.PolarPou
NO REFUND IF
LOST OR STOLEN.
on our bleachers! This is the best
view for live entertainment, the
craziest costumes and plungers!
Purchase VIP passes at Walker Home
Center or purchase at the plunge, if available.
Contact Jeff Holly at 218-547-1515.
DO SOMETHING CRAZY!
Our judges love to see you having a great
time! The team or individual with the craziest
costume or presentation will win Moondance
tickets (up to 10 tickets for a team win) along with
the bragging rights for that year! We’ve seen
everything from Elvis to a wedding ceremony
take place on our plunge stage! The sky’s the
limit- so show us what you’ve got!
(Just don’t jump in head first, please!)
The Walker Area Community Center is the home of the Boys and Girls Clubs of America, Walker Rotary Club, Walker Youth
Hockey, Walker Curling Club, Walker Just For Kix, Walker Tae Kwon Do and many more groups and events. The Polar Pout
Plunge is the largest fundraiser for the WACC, raising about $30,000 per year thanks to many dedicated volunteers & jumpers!
Keep track of your
AWESOME sponsors here!
Thank them for donating!
SPONSOR NAME
AMOUNT
HOW TO PARTICIPATE
13th Annual!
• Minimum cost to participate is $50.
• Jumpers earn prizes as individuals.
• Jumpers may combine into teams of 2-10 to
compete for team prizes.
• Prizes are awarded according to the amount of
money submitted at registration.
99.1
• Collect sponsor donations.
PAUL BUNYAN BROADCASTING
• Use the form on this brochure to keep track.
• Download more forms at our website.
• Register or check in at the Chase Convention Center
on Sat, Feb 20th, 2016 between 12:30-2:00.
• Jumping starts at 2:00. First come, first serve.
• Shoes are strongly encouraged.
• Do not bring valuables!
• Family appropriate attire is required
• Water is about chest deep, do NOT dive head first!
• Questions? Visit our website at polarpoutplunge.com.
Buy your
VIP Seats NOW!
$10 or 3/$20
Before they’re
gone!
WIN
TICKETS
FOR THESE TOP HONORS!
• Each $500 earned by a jumper
• Individual that raises the most money (1 ticket)
• Team that raises the most money (up to 10 tickets)
• Best team or individual presentation (up to 10 tickets)
2015 PPP RESULTS
• February 21st, 2015 2:00 PM
The Polar Pout Plunge is
dedicated to the memory of
Total Funds Submitted with this Form:
$
Make checks payable to: WACC
For additional forms and info:
• In Front of Chase On The Lake
Bill Bieloh. His dedication to
• Total Plungers: 98
the entire Walker community
• Total Teams: 26
will never be forgotten. In
this photo, Bill is on the
• Total Money Raised for WACC: $32,107
PolarPoutPlunge.com
right and next to him is
• Team High: Charlie’s Up North with $5,560
Call Jeff at 218-547-1515
Ken Bresley, founder of the
• Most Senior Plunger: John Tarbuck, Age 67
Registration is at the Chase Hotel
in the basement ballroom area.
Eelpout Festival.
• Best Team Costume: “Three Blind Mice”
www.PolarPoutPlunge.com
[email protected]
February 20, 2016
Registration 12:30-2:00 PM
Jumping begins at 2:00 PM
Held on Leech Lake in front of the Chase Hotel:
502 Cleveland Ave, Walker, MN 56484
Proceeds benefit:
WALKER AREA COMMUNITY CENTER
In conjunction with
THE INTERNATIONAL EELPOUT FESTIVAL