Ellen's Icebreaker Registration Form
If you plan to attend Ellen's Icebreaker, please complete the following form. One form per participant or spectator.

Saturday, March 4, 2017
Waukesha County's Naga-Waukee Park
Day of event: Please check-in between 10-11 a.m. Plunging will begin shortly after.
After completing this form, don't forget to donate online!

Note: If a plunger is under the age of 18, a parent or legal guardian must attend and sign a waiver. Waivers can be found on Ellensway.org.

Please select the activity you will be participating in *
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