Ice Bath Challenge 2025

My Details

Prefix

First Name *

Last Name *

Email *

Phone Number *

My Address

Address Line One *

Address Line Two

Town/City *

County

Postcode *

Country *

Date Of Birth *

T-shirt Sizes *

How did you find out about the Ice Bath Challenge? *

Are you taking part in memory of someone? If so, please let us know their name

Dietary requirements (please list any here)

Are you willing to share your story? *

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Your support is vital to Dorothy House and we'd love to share our news, campaigns and events with you, as well as ways you could get involved and provide support. Please choose your preferences below:

Post *

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E-mail *

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Please tick that you have read and accept the terms and conditions *

My Contact Details

Donations

We would like all entrants to aim to raise a minimum of £300, either in sponsorship or by making a personal donation.

Choose an amount:

�200

�100

�40

�10

Other (�)

No Donation

Gift Aid Declaration:

* I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference.

My Details

My Address

My Contact Details

Donations

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