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    Walker Registration Form

    Uploaded by

    Kendra Sikes
    Fido 5K Walk Walker Registration Form April 8, 2017 Jeffersonville, IN To benefit Southern Indiana Animal Rescue

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Walker Registration Form

    Uploaded by

    Kendra Sikes
    55 views1 page
    Fido 5K Walk Walker Registration Form April 8, 2017 Jeffersonville, IN To benefit Southern Indiana Animal Rescue

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

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    Fido 5K Walk Walker Registration Form April 8, 2017 Jeffersonville, IN To benefit Southern Indiana Animal Rescue

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    55 views1 page

    Walker Registration Form

    Uploaded by

    Kendra Sikes
    Fido 5K Walk Walker Registration Form April 8, 2017 Jeffersonville, IN To benefit Southern Indiana Animal Rescue

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Fido 5K Walk

    Saturday, April 8, 2017


    Jeffersonville, Indiana
    Registration starts at 7:30 am
    Walk begins at 9:00 am
    Hosted by Xi Beta Alpha to benefit Southern Indiana Animal Rescue (SIAR)
    Registration will be located at the Overlook on the corner of Spring St and Riverside Dr.
    Walk will begin at 100 E Riverside Dr and continue to 100 W Riverside Dr and back.
    Name
    Address
    City

    State

    Phone Number

    Zip Code

    Email Address

    Age

    Gender:

    Male

    Female

    Pre-registration fee: $25 (includes event t-shirt and a dog scarf) Deadline is March 8, 2017
    Day of event registration fee: $30 (event t-shirt ONLY available as they last)
    T-Shirt Size Please circle size: SM

    XL

    XXL

    How many dogs will participate?


    ALL DOGS MUST BE ON A LEASH!
    Additional dog scarves will be available for $5 if more than one pet walking.
    PAYMENT IN FULL MUST BE RECEIVED WITH YOUR APPLICATION:
    Make check payable and mail to:
    Xi Beta Alpha
    2104 Augusta Dr.
    Jeffersonville, IN 47130
    Release and Waiver (Please read and sign)
    I know that running/walking is a potentially hazardous activity. I should not enter and run/walk unless I am medically able and
    properly trained. I also know that, although police protection might be provided, there could be traffic on the course route;
    therefore, I assume the risk of walking in traffic. I also assume any other risks associated with running/walking in this event
    including, but not limited to, falls, contact with other participants, and the effects of weather and conditions of the road. I
    understand I am solely responsible for my own safety while traveling to and from or participating in this event. Knowing these
    facts and in consideration of your acceptance of my entry, I hereby for myself, my heirs, executors, administrators, or anyone
    else who might sue on my behalf convenant not to sue, and waive, release and discharge the sponsors or contributors to this
    event, any race officials, volunteers, the city and police agencies, their representatives, successors or assignees from any and all
    claims of liability for death, personal injury, or property damage of any kind or nature whatsoever arising out of, or in the
    course of my participation.
    The release form and waiver extends to all claims of every kind or nature whatsoever, foreseen and unforeseen, known and
    unknown. The undersigned further grants full permission to use any photographs, videotapes, motion pictures, recordings, or
    any other record of the event for any purpose. Minors will be accepted with parent/guardian signature.

    Signature
    Visit us on Facebook: @SIARFido5KWalk

    Date
    Email: Fido5KWalk@yahoo.com

    SIAR: www.sirescue.org

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