Northern Illinois Samoyed Assistance, Inc. Proudly Presents
Transcription
Northern Illinois Samoyed Assistance, Inc. Proudly Presents
Northern Illinois Samoyed Assistance, Inc. Proudly Presents Sam O Rama Old Fashioned Picnic Sunday, September 29, 2013 Registration Form Packet Activities Parade of Diamonds Parade of Champions Blessing of the Animals Merchandise Booth Rescue Booth Misc Games K-9 Costume Contest Buffet Items Burgers The largest Samoyed Event in the Midwest! Hot Dogs Fried Chicken Baked Beans Corn-on-the-cob Cole Slaw Potato Salad Arizona Salad Potato Chips Parade of Adopted Samoyeds Registration Form Check one: [ ] 2012—2013 Champions (Samoyeds adopted since last year and adopted Samoyeds attending for the first time) [ ] Alumni Champions (1995 –2013) (Samoyeds who already have their “I’m Adopted” scarves. There will be a group recognition and yearly ovals will be available at the registration booth) Fresh Fruit Salad Deviled Eggs Name: __________________________________________________ Year of adoption: _________ Brownies Samoyeds name: ______________________________________________ Current age: _________ Cupcakes Beverages Shelter or group adopted from: _______________________________________________________ & What you love most about your Samoyed: ______________________________________________ NISA’s Special Celebration Cake ________________________________________________________________________________ ________________________________________________________________________________ Sam O Rama Special ATTENTION: This years location, Grove #4 North: 94 South to 90 West (Rockford). Exit at Arlington Heights Road and turn left (South) to Higgins Road. Turn right on Higgins (West) to Busse Woods on the right side of road. It’s the second drive way on the right (North) side of Higgins. ***Grove number 4. Right Here at Grove number 4 South: 294 North to 90 West (Rockford) exit at Arlington Heights Road. Turn left (South) to Higgins Road and turn right (West) to Busse Woods entrance. West 55 or 88 to 355 North. Exit at Higgins near Woodfield Mall. Turn right (East) to the SECOND drive way on the left (North side of Higgins) Busse Woods entrance. 90 East to Arlington Heights Road exit. At the light turn right (South) to Higgins Road and turn right again (West) to Busse Woods entrance. East Any West bound main road that connects to Arlington Heights Road (North/South road) Higgins runs East/West. To Elk Grove area. ***Between Arlington Heights Road and Rt. 53 on Higgins*** There are only three entrances to groves. Grove 4 is the SECOND one on the North side. Hotels and Restaurants Near the Picnic Site Please be sure to ask if dogs are welcome Red Roof Inn 22 W Algonquin Rd Arlington Hts. (847-228-6650) Motel 6 441 W Algonquin Rd Arlington Heights (847-806-1230) Doubletree 75 W Algonquin Arlington Hts. (847-364-7600) Amerisuites 2111 S Arlington Heights Arlington Heights (847-956-1400) Holiday Inn (Restaurant on site) 3405 Algonquin Rolling Meadows (847-259-5000) Courtyard by Marriott 100 W Algonquin Rd Arlington Heights (847-437-3344) Fast Food and Restaurants on Algonquin Road and Golf Road McDonalds Burger King Taco Bell Oberwise Ice Cream Panera Bread Ritzy's Russel's Bar-b-que I-Hop AppleBees Pre-registration form for NISA’s Sam-O-Rama Picnic Fundraiser, September 29, 2013 PicnicBuffet available 12:30 to 2:30 Children ages 5 and under no charge Please Print Name: __________________________________________________________________________ Address: ________________________________________________________________________ City: _____________________________________ State: ________________ Zip: ____________ Phone: _______________________ E-mail address: _____________________________________ I hereby grant full permission to any and all of the foregoing to use my name, my pet's name, and our likenesses in any broadcast, telecast, video or print media report or advertising of the event without compensation. All participants Signature and date Parent or Guardian's Signatures & date (if under 18) Total Adult Meals: $ _________ Junior meals (ages 6-12): __ __@ $ 8.00 each Total Junior Meals: $ _________ Raffle Table Tickets _____ @ 6 for $5 Total Tickets: $ _________ Grand Total: $ ________ How many Samoyeds are you bringing? ________ **Please bring water and a bowl for your Fur-Friend** Circle payment preference: MASTER CARD VISA DISCOVER CARD Name on card: _______________________________ Acct # ____________________________ Expiration date: _______________ 3-digit CVC # on back of card: _________ Mail ALL forms (and a check if applicable, payable to NISA) postmarked by September 15, 2013 to: NISA Picnic c/o Donna Sharik 8408 Balder Drive Cary, IL. 60013-3008 SECTION Adult meals: __ __@ $ 15.00 each CHECK# ________ PULL OUT Pursuant to my participation in Sam O Rama to be held on the 29th day of September, 2013 at Busse Woods, Grove number 4, I hereby indemnify and hold harmless Northern Illinois Samoyed Assistance, Inc and its officers, agents, officials, employees, volunteers, representatives, and the Cook County Forest Preserve and its officers, agents, officials, employees, volunteers representatives, and all sponsors and participants for any and all claims which may arise from my family’s participation in the event including, but not limited to, injury, loss of property, or any other claim, whether known or unknown, arising from my participation, my family’s and my pet's participation. I further waive all rights and remedies that I, my family or my personal representatives, heirs, executors, administrators, agents and assigns, may have against said parties regarding any and all claims, causes of action, or other legal remedies including those related to negligent acts or omissions. I further acknowledge that I have read and understand this Indemnification and Hold Harmless Agreement and affix my signature hereto of my own free will. Sam O Rama Special Insert Sam-O-Rama Information Section Memories from years past... NONPROFIT ORGANIZATION U.S. POSTAGE PAID PALATINE, IL PERMIT NO. 00634 Northern Illinois Samoyed Assistance, Inc Inc Box 218 P.O. P.O. Box 218 Arlington Heights, IL 60006-0218 Arlington Heights, IL 60006-0218 Rescue Hotline: 847-255-4815 Fax: 847-392-5000 Email: [email protected] Recognized Affiliate of Endorsed by the SCA www.samoyedrescue.org Your membership provides HOPE to a HOMELESS Samoyed!!!!! P.S. - Do you know how much water your Do know much water your dog dogyou should behow drinking? should be drinking? Dogs should drink approximately 20 to 40 Dogs drink approximately 20 to per 40 ml of should water per pound of body weight ml water per pound of body day.ofThis comes out to about 3 toweight 4 cupsper of day. out todog. about 3 tothat 4 cups waterThis for comes a 20-pound Dogs eat of water a 20-pound dog. eat cannedfor food may drink lessDogs sincethat canned canned food may drink less sinceofcanned foods contain a high percentage water foods contain a high percentage of water compared to dry food. compared to dry food. Every Samoyed saved, every Samoyed adopted, every event and every step forward is achieved through TEAM work. Be it placing a stamp on the envelope or delivering a Samoyed to it’s new family, we all work toward the same goal and the thrill of success is shared by all. To insure NISA’s future, get involved! Printing services donated by: Allegra Print & Imaging - 510 East Northwest Highway - Palatine, Illinois 60074 Phone: (847) 963-0000 - Fax: (847) 963-0001 - E-Mail: [email protected]
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