Transcript Slide 1

Presented by
Saturday, September 19, 2009 –All Sports Park (Reinhart Park), 1690 Webster Road, Grants Pass, OR
9AM to 1PM, registration starts at 8:30AM - Rain or Shine
All walkers over the age of 18, with or without a dog, must complete this form.
Completion of this Liability Waiver and Release is required for participation in the dog walk.
Walker’s Name_________________________________________
LIABILITY WAIVER AND RELEASE
In registering to participate in Canine Angels Service Teams’ “Walk with the Angels” Dog Walk & Family Fun
Day, I (along with those under the age of 18 who are associated with me) hereby waive, release, and forever
discharge Canine Angels Service Teams, its directors, officers, agents, volunteers, and the City of Grants
Pass and the County of Josephine employees and agents, event officials, volunteers, sponsors, suppliers
and all other individuals and entities in any way assisting or connected with this event from any and all
claims and liability of whatever kind or nature whatsoever arising out of my participation in this event, even
those claims and liabilities that may arise as a result of the negligence or carelessness of individuals or
entities released by this Liability Waiver and Release. I assure that my participating dog(s), if any, is up to
date with all required vaccinations and is free of any contagious diseases. I grant full permission for the
organizers to use my name and quotations and photographs of me and/or my dog(s) for publicity or
promotional purposes without liability or obligation to me.
Street Address_________________________________________
City_______________________ State_________ Zip__________
Phone_________________ E-Mail Address__________________*
Number of Dogs _______
Adults: $10, Ages 7-18: $5, Age 6 and under: Free. To pre-register,
please enclose check and any additional donations (see below) and
mail before Sept. 12. You may also bring this registration form to the
Registration desk at the event.
______________________________________________________________________________
Signature of Walker (Parent/Guardian if under 18 years of age)
Date
I cannot participate, but I would like to support Canine Angels and help improve the life of a child by making a tax-deductible donation. My
friends, also listed below, would like to donate to this worthy cause. Please complete this form and mail check(s) (see below) or go to
Canine-Angels.org and donate through PayPal. Please make copies of this form if you have additional donations.
Name
Mailing Address*
E-Mail Address*
Donation
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Make checks payable to Canine Angels Service Teams and send to 13475 N. Applegate Rd. Grants Pass, OR, 97527
Canine Angels Service Teams is a 501(c)3 nonprofit organization (Tax ID No. 26-1514610)
*We do not share personal information with any other organization or entity.
www.Canine-Angels.org