| To pre-register,
print and complete this form and mail to the address below
or Click
Here to Register Online. Please make sure to sign the
disclaimer before sending this form. Disclaimers
MUST BE SIGNED and turned in before you can participate
in Walk-N-Wag! Pre-registration ends on June 7th,
2007. Register at Baker Park, June 9th 9:00 - 10:00 am.
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Payment: Check
Enclosed (payable to Frederick County Humane Society) |
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_____MC  _____Visa
_____Am. Ex. _____Discover
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Credit
card number |
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Expiration
date (MM/YY) |
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| Signature:
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| I
cannot participate in Walk-N-Wag but would like to donate
$
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Disclaimer: I, for myself, my heirs and administrators,
hereby signify that the Frederick County Humane Society;
sponsors of Walk-N-Wag; the City of Frederick; and all
other organizations and persons connected with this event
will not be held responsible for any injuries or damages
I or my pet might suffer as a result of our participation
in the June 9th Walk-N-Wag 2007 and I hereby waive any
claim for damages to my person or property. I hereby certify
that my dog is in good health and has all required vaccinations,
including rabies, and that my dog and I are physically
able to participate in Walk-N-Wag 2007. In addition, I
permit the use of our photo in brochures and other promotional
materials without compensation. I have read the entry
information and certify compliance by signing below.
____________________________________________________________________
Signature
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Walk-N-Wag
c/o Frederick County Humane Society
5712-D Industry Lane
Frederick, MD 21704
or fax it to us at: (301) 694-8305
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