If you have any questions or need help registering, please call our office 781-662-5359

The Weber Foundation of Helping Hands 2012 "Angels Splash for Cash" - New Years Day REGISTRATION FORM
First Name		Last Name
Home Phone Number		E-mail
Address		City
State		Zip Code

Goal Amount to Raise



Who are you raising donations for?	Helping Hands for Heroes Freedom Fund
	The Weber Foundation

Are you a committee Member?	I am a Committee Member No, I am NOT a Committee Member

If No, please list Committee Member who referred you:

Make sure you download the flyer and the Pledge Sheet Form! Participants: Plunge time to be announced, watch website www.theweberfoundation.com for updates. Please bring your pledge sheets and monies in a sealed envelope with your name and dollar amount raised on the day of the plunge and hand to Marika Merva. The Weber Foundation of Helping Hands, Inc. *WAIVER* Although all precautions are taken to ensure the safety of all those who plunge, participation in this event is at your own risk. The Weber Foundation of Helping Hands, Inc. does not recommend the “Angels Splash for Cash” TEAM for anyone with heart or medical problems. The Weber Foundation of Helping Hands, Inc. will not be responsible for any loss or damage. I, (Enter your name in the box above) agree to participate in the “Angels Splash for Cash” at my own risk and agree to hold The Weber Foundation of Helping Hands, Inc. Staff and Event Sponsors harmless and blameless in the event of injury or death resulting from participation in this event.
Electronic signature (name) of Participant (or guardian if under 18)
	Date

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