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
Never submit passwords through Google Forms.
This form was created inside of JX Enterprises. Report Abuse - Terms of Service - Additional Terms