If you are a Polar Plunge host, please complete this form to provide us with the details to set up your in-person plunge registration page. Note that this form is for in-person plunges only, as the virtual plunge will be provincially run.

Your Name(Required)

First Last

Email(Required)

Polar Plunge Name(Required)

(Community name)

Plunge Description(Required)

This text will appear on the front page of your plunge site - you may include any details specific to your plunge, including any social media, photo contests, etc.

Plunge Date(Required)

Start Time(Required)

End Time(Required)

Will registration begin earlier than the plunge start time?(Required)

Yes

If so, please indicate registration start time:(Required)

Please indicate your plunge's general registration fee:(Required)

Suggested registration fee is $30

Would you like to include a "fundraise to waive" registration option?(Required)

This will give registrants the option to register without paying a registration fee, with the understanding that they must fundraise to a certain point by the date of the Polar Plunge. Those who do not will be expected to pay the registration fee upon arrival at the plunge. NOTE: Plunge organizers will need to monitor these participants at arrival - your registration list will indicate those who did/did not meet the fundraising requirement.

Yes

What fundraising amount would you like set for your fundraise to waive option?(Required)

This is the amount that a registrant must fundraise to waive their registration fee.

If your plunge will have different registration fee levels, please describe those below:

Plunge Location(Required)

Actual place of the event

Street Address Address Line 2 City Province Postal Code

What is the overall fundraising goal for your plunge?(Required)

If your plunge has limited capacity, please indicate the maximum number of participants below (if not, you may leave this blank):

Plunge Registration Deadline

Note: plunges that do not specify a registration deadline will have their online registration automatically closed at 4:00 PM ET on the Thursday before the plunge.

If you are not the primary contact for the plunge, please indicate their name below:

First Last

Primary contact email:

If you require a waiver that is different from the provincial waiver, please provide an electronic copy:

Max. file size: 64 MB.

Will you require any additional information from registrants? Please list additional questions below:

Note: the following questions will be included by default for every plunge registrant: t-shirt size, law enforcement and/or Special Olympics community affiliation, vaccination status

Will a downloadable pledge form be needed?(Required)

Yes

Would you like weekly registration reports/updates?(Required)

Yes

Will a registration report be required for the day of the event?(Required)

Yes

Purchase Items

If your plunge has items for sale that you would like purchasable through the site, please list them below:

Product (with description)

Price

Quantity to be sold

If you have any logos (i.e. supporters, sponsors) that you would like included, please upload them below:

Please upload logos at their highest resolution.

Drop files here or

Max. file size: 64 MB.

ACKNOWLEDGEMENT OF TRADITIONAL LAND

We acknowledge that the Torch Run Ontario office is located on the traditional land of the Huron-Wendat, the Haudenosaunee, and most recently, the Mississaugas of the Credit First Nations.

This land is governed by the Dish with one spoon covenant between the Haudenosaunee Confederacy and the Confederacy of Ojibway and Allied Nations.

This covenant is an agreement to share, work and protect this land together in harmony.

Today, this meeting place is still the home to many Indigenous people from across Turtle Island and we are grateful to have the opportunity to work, live and play on this land.

If we can improve on this statement, please email us at info@specialolympicsontario.com.

Title

Host Request Form

CAD