Polar Plunge registration form

Complete and submit this form to register for our Polar Plunge.

  • To pay a £25 deposit to Rotherham Hospital and Community Charity when I register for the event. I understand that this deposit is non-refundable if I do not participate in the event. I agree to raise a minimum of £50 for the charity.  I agree to raise 80% of the funds 4 weeks before the event.
  • I will aim to meet the minimum fundraising target and deadline set by the charity otherwise I will cover the remaining amount myself and/or pull out of the event and refund the money raised to sponsors. I understand that it will be my responsibility to return any funds raised.
  • I understand that the charity does not accept any liability or responsibility for me taking part in the Rotherham Polar Plunge.
If you have set up your own JustGiving page, please provide the link.
Would you be happy for the charity to share information about your fundraising?
Keep in touch
We’d love to keep you posted with our news, activities and how you can help in other ways. We will never sell or swap your details with anyone else. You are free to change your mind at any time. Please indicate how you would like to hear from us by using the tick boxes below:
How did you hear about the event?

We will always store your personal details securely.

We’ll use them to provide the service that you have requested and communicate with you in the right way(s) that you have agreed to.  

Your data may also be used for analysis purposes to help up provide the best service possible.

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