Waiver of Liability Form Free Child Parade Participation - PDF by vfw86707


More Info
									2011 Pet Parade registration Form
You may also register online at www.atlantapetparade.org
Thank you for your interest in Pet Parade – A Walk for Animals. One registration form should be filled out for each
participant. Pledges are due on event day. Registration forms with checks or credit card payment should be mailed to:
    Attn: Pet Parade
    Atlanta Humane Society
    981 Howell Mill Road
    Atlanta, GA 30318
All pets walk free of charge. Children are not required to pay a registration fee but are encouraged to raise money for
the animals. A prize will be awarded to the top youth fundraiser (age 14 or under)! Youth t-shirts will be provided for
children raising the minimum registration fee of $30 advance/$35 day of the walk.
walker name

address                                                                                                                apt


phone (h)                                (w)                                  (c)
email address

t-shirt size (circle one)         s    m       l   xl    xxl

How did you hear about Pet Parade?

Fees (each participant must fill out entire form)
This form must be mailed for receipt on or before Friday, April 29. All advance registration ends on this date at midnight.
Those wishing to register after the deadline but prior to the walk may do so by coming to AHS (981 Howell Mill Road)
Monday, May 2 – Friday, May 6 between the hours of 10am-2pm for the “day of” rate of $35 per person.
    Individual – Advance rate $30 (Day of: $35)                                                             $ _________________________
    Collected sponsorships and donations:                                                                   $ _________________________
    I am unable to walk but enclosed is my donation of:                                                     $ _________________________
                                                                                           ToTAl:           $ _________________________
m My company will match my Pet Parade donation.
Charge to the following:           m American Express            m MasterCard         m VISA
Card number:                                                                                                Exp:
*Checks should be made out to atlanta Humane Society.
Create a PaCk! Organize a team with your friends, school, office or civic club to raise funds and have the
chance to win a team trophy! Team individuals will also win Pet Parade prizes relating to the amount raised. We welcome
your group of any size to walk with a banner and/or wear t-shirts to display your team spirit.
m I am part of Team
m My Team captain is                                                                                       (not required)
m I am interested in organizing a team. Please contact me with more information.
Waiver/release Form: In consideration and acceptance of this entry, I, on behalf of myself, my heirs, executors and administrators,
hereby waive and release all rights and claims of any nature I (or my child, if I am signing as a parent) may have against Atlanta Humane Society
and Society for Prevention of Cruelty To Animals, Inc., and all other supporters or sponsors, their officers, agents, employees, representatives,
successors and assigns (collectively and selectively referred to as “Sponsor”) for all injuries or death which I (or my child) may suffer in this walk
or in any way arising out of my (or my child’s) participation in this walk including pre-walk and post-walk activities. I agree to indemnify and hold
harmless each and every Sponsor from any and all liability, damage or expense (including, without limitation, costs of litigation and attorney’s
fees) that any Sponsor may suffer or incur in conjunction with any claims made by me (or my child). Additionally, I will allow free use of my
name and photograph (or that of my child) for broadcast or print if taken to publicize the walk. I am (or my child is) physically fit and sufficiently
trained for this event, and I do not request any Sponsor of the walk to attempt to verify or confirm that I am (or my child is) fit to participate in
this event. I am and will remain responsible for my animals participating with me (or my child.)

entrant’s signature                                                                                         date

parent’s signature if under 18                                                                              date

To top