Freezin' For A Reason Registration
Any participant pre-registered by January 5th, and raising $65.00 or more will receive a commemorative, long sleeve shirt, hot beverage and food the day of the event! Shirts are only guaranteed in this form is submitted by January 9th. Those who qualify for shirts will receive their shirts at the event. limited shirts will be available for purchase the day of the event
Participant's Name *
Your answer
Date of Birth *
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Age (anyone under 18 must have parent/guardian permission)
Street Address . *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Email Address: ( your registration packet will be emailed to you) *
Your answer
Emergency Contact: Full Name
Your answer
Emergency Contact: Phone Number
Your answer
Shirt Size (adult sizes) *
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AND PARENTAL CONSENT AGREEMENT (“AGREEMENT”)In consideration of participating in the Camp Fire 2018 Freezin’ for a Reason Challenge (Activity), I represent that I understand the nature of Camp Fire Freezin’ for a Reason Event and that I and/or my minor child am qualified, in good health, and in proper physical condition to participate in such activity. I acknowledge that if I and/or my minor child believe event conditions are unsafe, I and/ or my minor child will immediately discontinue participation in the activity. I fully understand that the Camp Fire 2018 Freezin’ for a Reason event involves risks of serious bodily injury, , including permanent disability, paralysis and death, which may be caused by my own actions or inactions, those of others participating in the event, the conditions in which the event takes place or the negligence of the “Releasees” named below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs and damages I and/or my minor child incur as a result of I and/ or my minor child’s participation in the Activity. I hereby release, discharge, and covenant not to sue Camp Fire, Camp Fire Sandusky County, Misty Meadows Inc, its respective administrators, directors, agents, officers, volunteers and employees, other participants, any sponsors, advertisers and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the “RELEASEES” herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the “Releases” or otherwise, including negligent rescue operations; and I further agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my and/or my minor child’s behalf, makes a claim against any of the Releases, I will indemnify, save, and hold harmless each of the Releases from any loss, liability, damage, or cost which any may incur as the result of such claim. I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, AND PARENTAL CONSENT AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect. I recognize that this event, like other sporting events, presents an element of risk. I certify that I am fully capable of participating in this challenging activity. I agree to assume all risks involved in this event and release, waive, discharge, hold harmless, indemnify and covenant not to sue any of the employees, volunteers, sponsors, or any and all agents associated with Camp Fire, Camp Fire Sandusky County, or any other organization directly or indirectly involved in this event. I hereby consent to and authorize the use and reproduction by Camp Fire, or anyone authorized by Camp Fire, of any and all photographs, audio and video recording, or any other records which are taken of me in conjunction with this event for any purpose whatsoever without any compensation to me. I have read this release and waiver of liability, assumption of risk and indemnity, and photograph/recording release and fully understand it. I agree to sign this form electronically by typing my full legal name on the below line, which will act in the same regard as a formal signature on a written paper. Please type Full Name below: *
Your answer
If participant is a minor: I as the participant's parent or guardian agree to sign this form electronically by typing my full legal name on the below line, which will act in the same regard as a formal signature on a written paper. Please type parent/guardian's Full Name below:
Your answer
Get Ready to Jump!!
Thanks for registering to Jump for Freezin for a Reason!
Participants will receive an email with your participant packet information within 24 hours. If you are excited about getting started you can obtain your participant packet and support materials which includes creative ways to raise money at our website www.campfiresc.org.

Thanks so much for supporting Camp Fire Sandusky County!!!
We look forward to seeing you January 19th!

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