HALLOWEEN BARK AT THE PARK

5K Scenic Dog Walk - Paul Skeffington Memorial Trail

Saturday, October 29, 2011 10 a.m. - Westbrook Park, DeWitt, Iowa
About 'Bark at the Park' This event is to raise money to help build a dog park in DeWitt. Supplies needed are fencing, benches, garbage cans and bag dispensers. All walkers welcome with or without a dog. This event will happen rain or shine, so be prepared. Dog costume contest and activities will begin after the walk. Entry fee includes doggy bag for each dog. After the walk, stop and visit the vendors to see products and services for your pets.

Contact Shelly or Kristy at paws.cause@hotmail.com

Check-in and Late Registration Saturday October 29, 2009, 9:00 AM 10:00 AM, Westbrook Park, DeWitt IA Pick up your doggy bag and shirt if you pre-ordered, or place your order for a shirt. Registration __________________________________ ____________________________________ First Name Last Name _________________________________________________________ Address _______________________ City ________ State _____________ Zip

Animal Size Small__________ Medium___________Large_______________ Payment $15.00 (for first dog): $5.00 (each additional dog): $10.00 (for walk without dog) $10.00 per shirt (pre-ordered) Donation to DeWitt Dog Park: TOTAL:

$______________ $______________ $______________ (per family) $______________ Circle size Adult S M L XL XXL (Add $2) $______________ Child S M L $______________

Make checks payable to: Paws for a Cause. Mail Registration Form and Payment to: 256 Sixth St., DeWitt, IA 52742

Waiver and Release Agreement MUST SIGN BELOW WARNING: READ CAREFULLY. THIS AGREEMENT INCLUDES A RELEASE OF LIABILITY AND WAIVER OF LEGAL RIGHTS AND DEPRIVES YOU OF THE RIGHT TO SUE PAWS FOR A CAUSE AND OTHER PARTIES. DO NOT SIGN THIS AGREEMENT UNLESS YOU HAVE READ IT IN ITS ENTIRETY. SEEK THE ADVICE OF LEGAL COUNSEL IF YOU ARE UNSURE OF ITS EFFECT. I understand that my consent to these provisions is given in consideration of the acceptance of this registration and for being permitted to participate in this event. I am a voluntary participant in this event, and in good physical condition. I KNOW THAT THIS EVENT IS A POTENTIALLY HAZARDOUS ACTIVITY AND I HEREBY ASSUME FULL AND COMPLETE RESPONSIBILITY FOR ANY INJURY OR ACCIDENT WHICH MAY OCCUR DURING MY PARTICIPATION IN THIS EVENT OR WHILE ON THE PREMISES OF THIS EVENT, AND I HEREBY RELEASE AND HOLD HARMLESS AND COVENANT NOT TO FILE SUIT AGAINST THE PAWS FOR A CAUSE, CITY OF DEWITT, STATE OF IOWA, AND ANY AFFILIATED INDIVIDUALS OR ENTITIES ASSOCIATED WITH THIS EVENT (THE "RELEASEES") FROM ANY LOSS, LIABILITY OR CLAIMS I MAY HAVE ARISING OUT OF MY PARTICIPATION IN THIS EVENT, INCLUDING PERSONAL INJURY OR DAMAGE SUFFERED BY ME OR OTHERS, WHETHER SAME BE CAUSED BY FALLS, CONTACT WITH PARTICIPANTS, CONDITIONS OF THE COURSE, NEGLIGENCE OF THE RELEASEES OR OTHERWISE. If I do not follow all the rules of this event, I understand that I may be removed from the competition. I give my full permission to PAWS FOR A CAUSE and their sponsors and corporate sponsors to use any photographs, videotapes or other recordings of me that are made during the course of this event.

I have read, understood, and accept the agreement above. Signature: __________________________________Date:__________ Parent/Legal Guardian if under 18 years of age: Signature: _________________________________Date: ___________