Polar Plunge County Roster Form

  • Section A: General Information

  • Click on box, then scroll to select County Program Name.
  • Section B: Event Information

  • Select Plunge site (s) plungers below will be participating at.
  • Section C: Plunge Team Roster

  • First NameLast Name 
    Please list the members of your team by first and last name.
  • Section D: Plunge Coordinator Agreement

  • I have read the plunge agreement and understand I will get a revenue split for each plunger I recruit and turn in on my plunge team roster. I also verify and commit to the following:
    1. I have personally recruited each participant on my roster.
    2. I will encourage my team throughout the plunge season and cheer their results on event day.
    3. I will write a Thank You to each team member.
  • MM slash DD slash YYYY