Jersey Animal Coalition: Dog Walkathon and Fair Registration Form


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Walkathon Registration Form

To register, please:

Fill out form below
Print and sign
Mail form and check (payable to JAC) to: JAC Dog Walkathon, P.O. Box 225, Maplewood, NJ 07040
Remeber to send proof of rabies immunization!

ENTRY RULES: Each person must fill out a separate form. All dogs must have proof of rabies vaccination to participate. No more than two dogs per person, please. Children under 15 must be with an adult.

Your Information
First Name:
Last Name:
Address:	Apt#:
City:
State:	Zip:
Phone:	Day: Evening:
JAC member \|\| Adult Child (15 or under)

Dog Information
# of dogs walking	Dog(s) adopted from JAC
Dog(s) Name:
Proof of rabies vaccination enclosed

Fees
(please check the appropriate box.)
$7 per adult || $5 per dog || $3 per child 15 or under (under 5 are free)
Sorry, I won't be able to participate, but I want to contribute. My donation of $__________ is enclosed.

Waiver of Liability: I agree to absolve JAC and all other individual or organized sponsors of any blame or liability, misadventure, harm, or inconvenience suffered in any of the activities associated with the event. I will be responsible for the conduct of my pet and for keeping my pet leashed at all times. I will additionally permit the use of our names and pictures in broadcasts, newsletters, and/or promotional materials.

Signature _____________________________________________
(parent or guardian if under 18)

Questions? Call 973-763-7322

walkathon-fair information || walkathon sponsorship form