2010 Paws 4 A Cure Walk Mail-In Registration Form

Please complete the mail in registration form online then print the form and mail it to Paws 4 A Cure with your $20 donation/registration fee to P.O. Box 1821, Wakefield, MA, 01880.  Checks are to be made payable to Paws 4 A Cure, please put in the memo field WALK REGISTRATION.

* = Required Fields

First Name *
Last Name *
Email Address *
Street Address *
City *
State *
Zip Code *
Date of Birth *
Name of dogs walking with you:

Do you have a dog with cancer?   YES / NO

What form of cancer?
Walking in memory of:
How did you hear about the walk?

Fundraising Goal: $

 

Would you like to be notified when someone sponsors you? YES / NO

I am interested in volunteer opportunities?

I Agree to waiver below

 
RELEASE & CONSENT

I understand and agree that I am voluntarily participating in the Paws 4 A Cure 2010 Canine Cancer Walk and agree that "Participant" shall mean any individual (s) walking and taking part in the festivities with or without family members or pet(s). In consideration of my participation in the Event, I agree that participating in Event includes an element of risk for both me and/or my pet(s). I hereby represent that my pet(s) and/or I are physically able and properly conditioned to participate in the Event and that the pet(s) that will be participating with me is/are current on all vaccinations. I agree to abide by the rules of the Event and by any decision of an Event official relative to the pet(s)’s and my ability to participate in this Event safely, and I further agree that Event officials may authorize necessary emergency treatment for me and/or my pet(s). I hereby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, covenant not to sue, and hereby waive, release and forever discharge Paws 4 A Cure, its directors, officers and employees, Event officials, volunteers, and any sponsors, suppliers, agents, independent contractors, employees and other personnel in any way associated with the Event from any claims or liability of any kind whatsoever arising out of my or my pet(s)’s participation in the Event, including both pre-Event and post-Event activities, even though such liability may arise out of negligence or carelessness on the part of the persons or parties named in this Consent and Release which might be associated with my participation as a participant in the Paws 4 A Cure Canine Cancer Walk. I agree that vehicle traffic, other pet(s) and spectators may be present at the Event and I assume the risk of participating under such conditions. I further assume any and all other risks associated with participating in the Event including, but not limited to, illness, traveling to and from the Event, falls, contact with spectators, other participants or pets, the effects of the weather and the surface conditions.

PHOTO RELEASE

I understand and give permission for Paws 4 A Cure, their agents and others working for it and those acting under their permission or upon their authority the free use of my name, picture audio video recordings and that of my minor family members and/or pet(s) in any broadcast, telecast, print account or any other account in any medium for publicity or promotional purposes. I hereby waive any right I may have to inspect and approve the final reproductions or any copy that may be used in connection therewith or the use to which it may be applied and I hereby release, discharge, and agree to hold Paws 4 A Cure harmless from all liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the recording of said reproductions or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims of libel or invasion of privacy.