2015 Pledge Form - Dunn County Humane Society

2015 Pledge Form
Dunn County Humane Society
Participant’s Name ____________________________________
Pre-register, collect pledges or register the day-of the event.
How to collect pledges
Pet’s Name(s) ____________________________________________
Address __________________________________________________
Walkers without pets
are always welcome!
City ___________________________ State ______ Zip ___________
Participant Category (check only one)
Adult (ages15+)
Youth (ages 14 & under)
* There will be fantastic prizes for the adult and youth who raise the most amount of pledges! *
Important Notice: I, intending to legally bind myself, my pet(s), my children, administrators, personal representatives or assignees or
any party holding a durable power of attorney for my actions, do hereby release Dunn County Humane Society (DCHS), it’s employees,
affiliates, Board, or volunteers from responsibility for injury or damages to wither myself, my pet(s), or my children as a result of my
participation in this event. I grant permission for use for publicity or promotional purposes my name, my or my children’s pictures, or
my pet’s photo without liability or obligation to me. Entries from minors will be accepted with a parent or legal guardian signature.
Signature of Participant ______________________________________________
Signature of Parent/Guardian (if participant is under 18) ______________________________________
Name of pledger
Pledger’s Address
Pledge Paid
Amount
- Ask friends, family, co-workers etc. to pledge money towards
your walk or run.
- Collect the money and bring your completed pledge form(s) to
the registration line at 10am the day of the event.
Collect the most pledges in your category (adult or youth) & get a great prize!)
- Raise $50 or more in pledges, your registration fee is waived &
receive a free t-shirt! (Adult Size________ or Youth Size_______)
Pre-registration by noon on May 9th is strongly
encouraged for participants not raising pledges.
Pre-Registration
Pre-Registration deadline is May 9th at noon sharp!
To pre-register, stop by the shelter or mail completed registration
form and check payable to DCHS to: Dunn County Humane Society –
302 Brickyard Road – Menomonie, WI 54751. Your free t-shirt(s) will
be held for you at the registration table the day of the event.
- $25 per participant & receive a free t-shirt !
(Adult Size________ or Youth Size_______)
-$50 for family & receive 2 free t-shirts
(Adult Size(s)_____________ or Youth Size(s)_____________)
Day-of Event Registration
- Day-of Registration - $25 per person or $50 registration fee for
families of 2 or more. (t-shirts can be purchased for $10 at the event
while supplies last)
The first 100 pets receive a free goodie bag
All pets must be up to date with Rabies vaccination. A current
distemper-parvo vaccination is strongly encouraged for dogs.
All dogs must be on a 6 foot or shorter leash at all times & all
cats safely contained in a carrier or pet stroller.
(This form may be duplicated.)
Total Pledges Raised _______________
Questions? E-mail: [email protected]