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Host Request Form
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)
MM slash DD slash YYYY
Start Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
End Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Will registration begin earlier than the plunge start time?
(Required)
Yes
No
If so, please indicate registration start time:
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Plunge Location
(Required)
Actual place of the event
Street Address
Address Line 2
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
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.
MM slash DD slash YYYY
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
Add
Remove
Will a downloadable pledge form be needed?
(Required)
Yes
No
Would you like weekly registration reports/updates?
(Required)
Yes
No
Will a registration report be required for the day of the event?
(Required)
Yes
No
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
Add
Remove
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
Select files
Max. file size: 64 MB.
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Your ticket for the: Host Request Form
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Host Request Form
CAD