2015 Walker Registration & Liability

7th Annual Rochester Hope for Pets Dog Walk & Pet Expo
Saturday, June 13, 2015
Highland Park, Lilac Arches
(between Goodman St. and South Ave.)
$15 registration fee per walker; *First 100 adults to register receive
Rochester Hope For Pets T-Shirt free!! (NO charge for children under
13 with parent or guardian)
Check-in opens at 9 a.m. ◊ Walk starts at 10:30 a.m.
Top Fundraiser Raffle Prizes Include iPad
Kid’s Events Include Face Painting, Bounce House, and Educational Tables
City _________________________________________ State ______________ Zip Code______________
Email _________________________________________ Phone__________________________________
*Number of dogs walking with you, if any: ________
*All dogs attending are required to be up-to-date on vaccines, well behaved,
comfortable with people and other dogs, and on a leash at ALL times.
___ Enclosed is my $15 per person Dog Walk registration fee Circle size(s): S
*T-shirts for paying registrants, child sizes unavailable.
___ In addition to my participation, I will fundraise for Rochester Hope for Pets. (**See details below**)
___ I will not be attending the Walk but would like to make a tax-deductible donation of $______.
All participants must sign the liability waiver on the back of this form.
MAKE CHECKS PAYABLE TO: Rochester Hope for Pets
Rochester Hope for Pets
7 Annual Dog Walk & Pet Expo
2816 Monroe Avenue
Rochester, NY 14618
To register online, go to: rochesterhopeforpets.org/support-us
Select “Event Participation” in the pull-down menu and fill in text box with “2015 Dog Walk Registration”
**If you are fundraising**
You can fundraise online via Crowdrise at: www.crowdrise.com/2015RHFPDogWalk
You can print out a Fundraising Tracking Form off our website at: http://rochesterhopeforpets.org/category/activities-andevents/
(Please clearly fill out donor details, so that we can mail acknowledgement letters to your walk sponsors.)
* Teams that raise more than $1,000 in donations will be entered into the drawing to win the suite at Sahlen Stadium scheduled
for Friday, June 19, 2015.
**Individuals who raise more than $500 in donations will be entered into the drawing to win an iPad.
* Date for use of suite at Sahlen Stadium is not negotiable.
**Individuals who fundraise as part of a team, and also decide to individually fundraise are not eligible to be entered in the IPad drawing.
If you have any questions, please contact us at 271-2733 x89 or [email protected]
Rochester Hope for Pets
2816 Monroe Ave.
Rochester, NY 14618
Waiver and Release of Liability and Indemnification
Please read this form carefully and be aware that in consideration for participation in this event, you will be expressly
assuming the risk and legal liability and WAIVING and RELEASING all claims for injuries, damages or loss which you
or your dog(s) might sustain as a result of participating in any and all activities connected with and associated with this
Warning of Risk
Dog activities are intended to provide a fun and rewarding experience for a dog(s) and its owner. However, despite careful
and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury,
including death to either the dog(s) or its owner. Certain inherent risks include the propensity of any dog to behave in
dangerous ways that may result in injury to another patron or dog(s). Other risks include, but are not limited to the
inexperience, negligence or irresponsibility of a dog owner; the inability to predict a dog’s reaction to sound, movements,
objects, persons, or other animals; and actions by the dog(s) due to fright, anger, stress, insect bites, or natural reactions
such as jumping, pulling, resisting and biting. Other risks include the hazards associated with environmental and traffic
conditions, acts of God, inclement weather, slipping, falling, and/or premises defects.
I recognize and acknowledge that there are certain risks of physical injury to the dog(s) and its owner in association with
participating in dog activities, and I voluntarily agree to assume the full risk of any injuries, damages or loss, regardless of
severity, that I or my dog(s) might sustain as a result of participating in any and all activities connected with or associated
with this event. I do hereby agree to waive, relinquish, release and forever discharge Rochester Hope for Pets including its
owners, partners, and volunteers from any and all claims for injuries, damages or loss that I or my dog(s) may have or
which may accrue to me and arising out of, connected with, or in any way associated with this event. I have read and fully
understand the above important information, warning of risk, assumption of risk and waiver and release of all claims.
I, the undersigned, am executing the following Waiver and Release of Liability and Indemnification Release as a
participant in the Dog Walk offered at Highland Park, Highland Avenue, Rochester, NY 14620 hosted by Rochester Hope
for Pets. By signing below, I, as a participant, expressly understand, assume and consent to all the terms, conditions and
risks set forth herein. Also I do not hold Rochester Hope for Pets owners, partners, and volunteers liable for any such risk
as illness, injury, paralysis, death and/or other losses and damages sustained by me or my dog(s) arising out of or in
connection with the participation in the Dog Walk hosted by Rochester Hope for Pets.
I, the undersigned acknowledge that my dog(s) has received and is current on all of the necessary vaccinations, including
the rabies vaccine.
Acknowledgement of Release of Terms and Conditions
I, the undersigned, hereby represent that I have carefully read and fully understand the contents of this release and that this
release is legally binding and enforceable, and that I agree to the terms and conditions of this release.
Print Name: _________________________________________
How did you find out about our event?
Sign Name: _________________________________________
Pet’s (Pets’) Name(s): __________________________
____Family/Friend ____Other
Date: ________________
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