***NEW LOCATION THIS YEAR:
Please
make your check payable to WRNT (Westie Rescue of
and
mail it along with your form to:
WestieWalk
C/O Elizabeth Escobar
Pre-Register
Suggested Donations: 1 Dog $15 _____
2+Dogs $25 ______ Other Donation $___________
(Same
day registration accepted the day of the Walk.)
Owner(s)
Name:
___________________________________________________________________________________________________________
Address:
___________________________________________________________________________________________________________
Preferred Method of Contact for next year’s WestieWalk and other
events:
Email:
___________________________________
Phone(s): __________________________________
BREED
Dog
Name(s) Birthday Westie Other Rescue?
_______________________________ ______________________ ___ Yes __________________ ___ Yes
_______________________________ ______________________ ___ Yes __________________ ___ Yes
_______________________________ ______________________ ___ Yes __________________ ___ Yes
(Water for pets and humans will be available.)
WAIVER AND RELEASE
1. All participants, regardless of age, must
sign a liability waiver and photo release:
If you are under 18 years of age, a parent or guardian must also sign
this waiver. Anyone under the age of 13 must be accompanied by a parent or
guardian.
2. I agree
to release WestieWalk, the City of Carrollton, its event workers, participating
event organizations, sponsors, volunteers and their representatives or others
from any and all claims that may arise as a result of any expenses, personal
injury, injury to my animal(s), and loss or damages incurred by me or my
animal(s) during my and my animal(s) participation in WestieWalk.
3. I also agree to indemnify WestieWalk and the
City of Carrollton from any and all claims that may arise from my conduct or my
animal(s) conduct that results in expenses, personal injury, injury to my
animal(s), and loss or damages incurred by anyone else during my participation
in WestieWalk.
4. I consent to and authorize the use or
reproduction by WestieWalk and any appointed agents authorized by
WestieWalk, of any and all photographs,
video reproductions, motion pictures, or other record taken this day, including
without limitation, pictures and sounds of my animal(s), myself, alone or with
others, or minors accompanying me for any reasonable purpose, without
compensation to me.
5. I assume
full responsibility for myself and the welfare and control of my animal(s) at
all times during the event. My animal(s)
have been properly registered and have current vaccinations. My animal(s) and I
are in proper physical condition to participate in WestieWalk.
Name:_____________________________ Signature:___________________________Date:___________________
This is to certify that I, as parent or guardian
with legal responsibility for this participant, do consent and agree to my
minor child’s involvement or participation in WestieWalk as stated in the above
liability waiver and photo release statements.