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For more information, please contact the Genesee County Humane
Society at (810) 744-0511.
REGISTRATION FORM
Participant
Name____________________________________________________________________________
Address
__________________________________________________________________________________
City, State, Zip
_____________________________________________________________________________
Phone (_______)
___________________________________________________________________________
WAIVER:
In consideration of your accepting this entry form and allowing me
to participate in the 2005 Dog Walk/Run, I hereby for myself, my
heirs, executors and administrators waive and release all rights and
claims for damages I or my dog may have against the 2005 Dog
Walk/Run, the sponsors of the event, its agents, representatives,
successors and assigns for any and all claims, injuries, actions and
causes of action suffered by myself or my dog at said 2005 Dog
Walk/Run or which may arise out of traveling to, participating in
and returning from this event. I also accept full responsibility for
all action and behavior of my dog during said event and agree to
indemnify the HSGC for any liability it incurs arising from any
action by myself or my dog against a third party during the 2005 Dog
Walk/Run.
Participant Signature
___________________________________________________________________________
Participant Signature _______
___________________________________________________________________
Parent/Guardian Signature (If
participant is under 18 years of age.)
Registration Fee:
$25 (Entrance fee, T-Shirt, Goodie Bag) Please Circle
T-Shirt Choice: M L XL XXL XXXL
$15 (Entrance fee, Goodie Bag) (Adult Sizes)
Enclosed: $______________
Entrance fee can be combination of Pledges/Cash or totally
Pledges or Cash. Please hand in this sheet with the donations you
have collected at pre-registration at the Humane Society or at the
Walk/Run itself.
Donor checks must be payable to HSGC (Humane Society of Genesee
County.)
Registration begins at 12 Noon at the Walk/Run.If additional
space is needed, please attach a separate piece of paper.)
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