Codorus State Park
Presents…
Chicken Dance & Chicken Plunge Main Launch/Bandshell Area - Codorus State Park Saturday, January 16, 2016 (snow date Saturday, January 23, 2016)
Registration Opens 10AM Eagle Plunge 11AM-2PM – Winter Festival 10AM-3PM Chicken Dance & Plunge 1PM (just take a few steps in the lake) MAIL YOUR COMPLETED REGISTRATION & PAYMENT TO: Friends of Codorus State Park 1066 Blooming Grove Road Hanover, PA 17331 Phone: 717-451-3635 Email: [email protected] Proceeds raised from this event will be used toward the betterment of Codorus State Park.
SIGN ME UP!! FOOT PROTECTION IS REQUIRED TO PARTICIPATE ALL MINOR PARTICIPANTS MUST BE ACCOMPANIED BY AN ADULT OVER 18 YEARS OF AGE
Name: ___________________________________________________________________________________________ Address: _________________________________________________________________________________________ Phone: ______________________________________ Email: _______________________________________________ Signature: ____________________________________Date ________________________________________________ Registration Fee $35.00
Cash: ______________
Check #: _______________
**REGISTER BEFORE 12/25/2015 TO RECEIVE A FREE T-SHIRT OR CHICKEN PLUNGE HAT ** FOR REGISTRATIONS AFTER 12/25/2015: T-shirts will be available during the event for $10.00 per shirt. (Please include payment for shirt with completed registration form.) Size: _____Small ______Medium _____Large _____XL _____2XL _____3XL
OR
_______CHICKEN HAT
Access for People with Disabilities – if accommodations are needed to participate in the Eagle Plunge Event please contact the Friends of Codorus at 717-451-3635 In consideration of participating in the Friends of Codorus State Park’s Eagle Plunge, I represent that I understand the nature of the event, I represent that I am, and my minor children participating are, qualified to participate, in good health, and in proper physical condition to participate in this event. IT IS STRONGLY ADVISED PARTICIPANTS CONSULT THEIR PHYSICIAN BEFORE ATTEMPTING THIS EVENT and I acknowledge that I have been advised by the Friends of Codorus State Park to consult my physician prior to participation. I acknowledge that if the event should be unsafe for me or my minor children, I will immediately discontinue participation. I understand there may be risks involved such as serious bodily injury, including disability or death, which may be caused by my actions, actions of others, and/or conditions in which the event takes place. I also understand there may be other risks not mentioned at this time. By entering the Eagle Plunge presented by the Friends of Codorus State Park, I understand and agree to allow my image (and images of my minor children) to be used in materials to promote and/or advertise Codorus State Park. I (and my minor children) agree to hold harmless the Friends of Codorus State Park and the Commonwealth of Pennsylvania representing Codorus State Park, and any/all persons acting under the authority to promote the Eagle Plunge, from any and all claims, liability and discharge and covenant not to sue, which could arise by my participation in this event. I waive the right to inspect and/or approve the finished product or advertising which may be used in connection to this event. I fully accept and assume all risks and responsibilities for losses, costs and damages that I incur in connection to my (or my minor children) participation, in the event. I hereby release all claims, demands, losses or damages of any kind, whether sustained by me or my minor children, whether caused in whole or part by the negligence of Releasees or otherwise, including negligent rescue operations. I further agree that if, despite this release, waiver of liability and assumption of risk, anyone makes a claim against the Releasees on behalf of me or my minor children, I will indemnify, save and hold harmless each of the Releasees from any loss, liability, damage or cost which may arise from such claim.
REGISTER AS A TEAM FOR THE EAGLE PLUNGE $35.00 PER PERSON Registration Opens 10AM Eagle Plunge 11AM-2PM – Winter Festival 10AM-3PM Chicken Dance & Plunge 1PM (just take a few steps in the lake)
The team who raises the most money will receive a prize! (Prize to be determined by the Eagle Plunge Committee) **REGISTER BEFORE 12/25/2015 TO RECEIVE A FREE T-SHIRT OR CHICKEN PLUNGE HAT ** FOR REGISTRATIONS AFTER 12/25/2015: T-shirts will be available during the event for $10.00 per shirt. (Please include payment for shirt with completed registration form.) TEAM NAME
_____________________________________________________________________________________________________________________
TEAM LEADER
_____________________________________________________________________________________________________________________
NAME
ADDRESS
PHONE
TOTAL MONIES RAISED
1.
$
2.
$
3.
$
4.
$
5.
$
6.
$
7.
$
8.
$
9.
$
10.
$
11.
$
12.
$
13.
$
14.
$
15.
$
16.
$
17.
$
18.
$
19.
$
20.
$
TOTAL COLLECTED
$
SIGNATURE
Chicken Dance & Chicken Plunge Main Launch/Bandshell Area - Codorus State Park Saturday, January 16, 2016 (snow date Saturday, January 23, 2016)
Registration Opens 10AM Eagle Plunge 11AM-2PM – Winter Festival 10AM-3PM Chicken Dance & Plunge 1PM (just take a few steps in the lake) MAIL YOUR COMPLETED REGISTRATION & PAYMENT TO: Friends of Codorus State Park 1066 Blooming Grove Road Hanover, PA 17331 Phone: 717-451-3635 Email: [email protected] Proceeds raised from this event will be used toward the betterment of Codorus State Park.
SIGN ME UP!! FOOT PROTECTION IS REQUIRED TO PARTICIPATE ALL MINOR PARTICIPANTS MUST BE ACCOMPANIED BY AN ADULT OVER 18 YEARS OF AGE
Name: ___________________________________________________________________________________________ Address: _________________________________________________________________________________________ Phone: ______________________________________ Email: _______________________________________________ Signature: ____________________________________Date ________________________________________________ Registration Fee $35.00
Cash: ______________
Check #: _______________
**REGISTER BEFORE 12/25/2015 TO RECEIVE A FREE T-SHIRT OR CHICKEN PLUNGE HAT ** FOR REGISTRATIONS AFTER 12/25/2015: T-shirts will be available during the event for $10.00 per shirt. (Please include payment for shirt with completed registration form.) Size: _____Small ______Medium _____Large _____XL _____2XL _____3XL
OR
_______CHICKEN HAT
Access for People with Disabilities – if accommodations are needed to participate in the Eagle Plunge Event please contact the Friends of Codorus at 717-451-3635 In consideration of participating in the Friends of Codorus State Park’s Eagle Plunge, I represent that I understand the nature of the event, I represent that I am, and my minor children participating are, qualified to participate, in good health, and in proper physical condition to participate in this event. IT IS STRONGLY ADVISED PARTICIPANTS CONSULT THEIR PHYSICIAN BEFORE ATTEMPTING THIS EVENT and I acknowledge that I have been advised by the Friends of Codorus State Park to consult my physician prior to participation. I acknowledge that if the event should be unsafe for me or my minor children, I will immediately discontinue participation. I understand there may be risks involved such as serious bodily injury, including disability or death, which may be caused by my actions, actions of others, and/or conditions in which the event takes place. I also understand there may be other risks not mentioned at this time. By entering the Eagle Plunge presented by the Friends of Codorus State Park, I understand and agree to allow my image (and images of my minor children) to be used in materials to promote and/or advertise Codorus State Park. I (and my minor children) agree to hold harmless the Friends of Codorus State Park and the Commonwealth of Pennsylvania representing Codorus State Park, and any/all persons acting under the authority to promote the Eagle Plunge, from any and all claims, liability and discharge and covenant not to sue, which could arise by my participation in this event. I waive the right to inspect and/or approve the finished product or advertising which may be used in connection to this event. I fully accept and assume all risks and responsibilities for losses, costs and damages that I incur in connection to my (or my minor children) participation, in the event. I hereby release all claims, demands, losses or damages of any kind, whether sustained by me or my minor children, whether caused in whole or part by the negligence of Releasees or otherwise, including negligent rescue operations. I further agree that if, despite this release, waiver of liability and assumption of risk, anyone makes a claim against the Releasees on behalf of me or my minor children, I will indemnify, save and hold harmless each of the Releasees from any loss, liability, damage or cost which may arise from such claim.
REGISTER AS A TEAM FOR THE EAGLE PLUNGE $35.00 PER PERSON Registration Opens 10AM Eagle Plunge 11AM-2PM – Winter Festival 10AM-3PM Chicken Dance & Plunge 1PM (just take a few steps in the lake)
The team who raises the most money will receive a prize! (Prize to be determined by the Eagle Plunge Committee) **REGISTER BEFORE 12/25/2015 TO RECEIVE A FREE T-SHIRT OR CHICKEN PLUNGE HAT ** FOR REGISTRATIONS AFTER 12/25/2015: T-shirts will be available during the event for $10.00 per shirt. (Please include payment for shirt with completed registration form.) TEAM NAME
_____________________________________________________________________________________________________________________
TEAM LEADER
_____________________________________________________________________________________________________________________
NAME
ADDRESS
PHONE
TOTAL MONIES RAISED
1.
$
2.
$
3.
$
4.
$
5.
$
6.
$
7.
$
8.
$
9.
$
10.
$
11.
$
12.
$
13.
$
14.
$
15.
$
16.
$
17.
$
18.
$
19.
$
20.
$
TOTAL COLLECTED
$
SIGNATURE
