Quincy Animal Shelter’s 6th Annual
P.O. BOX 690088, Quincy MA 02269 (617) 376-1349 quincyanimalshelter.org
Emceed by Sorboni Banerjee, Fox News
Sunday October 19th DCR Squantum Point Park, Marina Bay, Quincy MA
10:00am Road Rac e 10:15am Dog Walk
Best Dog Halloween Costume Contest
Please read and sign Waiver on back of this Registration Form.
Register before 10/1/14 for t-shirt. Thank you
QAS is a recognized 501(c)(3) organization. Registration fees are donations that are tax deductible to the extent of the law.
Quincy Animal Shelter’s 6th Annual
P.O. BOX 690088, Quincy MA 02269 (617) 376-1349 quincyanimalshelter.org
QAS’ Cause 4 Paws 5k Mile Run & 1 Mile Dog Walk
RELEASE & WAIVER:
I know that running, walking, and road races are potentially hazardous activates. I will not enter and run in the October 19, 2014 Cause 4 Paws 5k & 1 Mile Dog Walk: Quincy Animal Shelter Fundraiser unless I am medically able and properly trained. I agree to abide by all decisions of a race official relative to my ability to safely complete the event. I assume all risk associated with participation in this event including, but not limited to, falls, contact with other participants, the effects of weather, including low temperature and/or precipitation, traffic, and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of our accepting my entry, I myself and anyone entitled to acting on my behalf, waive and release all race organizers, the state of Massachusetts, the city of Quincy and all other municipalities, all volunteers, all sponsors, their representatives, and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons names in this waiver.
I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. I agree to receive email correspondence from the Quincy Animal Shelter, if an email address was provided. I acknowledge that entry fees are non-refundable and non-transferable for any reason.
I agree that any dog or animal participating in the October 19, 2014 Cause 4 Paws 5k & 1 Mile Dog Walk: Quincy Animal Shelter Fundraiser, is the liability and responsibility of the entrant below. I certify that the dog/s is current on rabies vaccinations, securely leased, friendly and social with people and other dogs. Dogs and their owners or caretaker will be asked to leave the event if there is a concern about the dog’s ability to interact with other dogs. Dogs with a history of biting or aggression towards humans or other dogs are strictly prohibited. I assume all risk associated with participation of a dog in this event including, but not limited to, biting of humans or other animals, destruction of property, the health and wellness of the animal in weather, including temperature and precipitation, all such risks being known and appreciated by me.
By signing below, I certify that I have read, understand, and agree to the release/waiver for Cause 4 Paws 5k & 1 Mile Dog Walk: Quincy Animal Shelter Fundraiser, and that I have been offered a copy for my records.
Name:__________________________________________________________________________________
Address:_________________________________________________________________________________
City/State/ZIP:____________________________________________________________________________
Email:__________________________________________________________________________________
Signature:_______________________________________________________________________________
(signature of parent or guardian if under 18)
Date:_____________________________________
QAS is a recognized 501(c)(3) organization. Registration fees are donations that are tax deductible to the extent of the law.