RD Annual Putnam County Animal Shelter!! The 3RD Annual Putnam County Animal Shelter !...
Transcript of RD Annual Putnam County Animal Shelter!! The 3RD Annual Putnam County Animal Shelter !...
REGISTRATION FORM
The 3RD Annual Putnam County Animal Shelter
2016 DOG JOG 5K RUN & WALK
REGISTRATION FORM Putnam County’s Largest 5k Run & Walk May 14th, 2016. Race day registration begins at 6:45am. Race begins at 8:00am, Valley Park, Hurricane, WV
ALL profits benefit the Putnam County Spay and Neuter Fund!!!
Mail Registration forms to: Dog Jog 5k Run and Walk Attn: Registration 3744 Teays Valley Road, Suite 209 Hurricane, WV 25526 Make Checks Payable to: The Putnam County Animal Shelter (write “Dog Jog” on the memo line.) REGISTRATION MUST BE RECEIVED BY APRIL 28TH TO GUARANTEE SHIRT AND SIZE.
If pre-‐registering before April 28th, 2014, please remit $20. If pre-‐registering April 29th or later, please remit $25. Race Day registration will be from 6:45 to 7:30am and will cost $25. Please note that your selected shirt size is only guaranteed for pre-‐registrations received by April 28th. You may also pre-‐register online at tristateracer.com.
Registrant: _________________________________________ _________ (M/F) ________ (S, M, L, XL, XXL) _______ (Please Print) First Last Age Gender Shirt Size ________________________________________________________________________________ ___________________________ Street City State Zip Phone Must be signed or entry will not be accepted. In consideration of the acceptance in the Dog Jog 5k Run & Walk, I undersigned, intending to be legally bound, hereby for myself, my heirs, executors, and administrators waive and release any and all right and claims for damages I may have against the City of Hurricane, the Putnam County Animal Shelter, the Putnam County Commission, the Putnam County Convention and Visitors Bureau, the Putnam County Parks and Recreation Commission, and any other individuals or organizations assisting with the Dog Jog 5k Run & Walk, and for any and all injuries suffered by me in this event. I attest and verify to the best of my knowledge my physical condition and fitness are adequate for me to safely compete and no physician or qualified individual has advised against me competing in this event. _____________________________________________________________________________________________________________ Signature (REQUIRED) (Parent Signature if Under 18) Date