Entry Form:
(enter only one race per dog)

One-Mile Walk/Run (  ) Two-Mile Run (  ) Spectator Only (  )
Owner Name: ¨
Address
City State Zip
Phone Age Sex
T-shirt size(s)   XS* (  )    S (  )    M (  )     L (  )    XL (  )
(One short sleeve T-shirt included with each entry, for owner or dog.) *Will fit small-to-medium dog.
Dog Name: ¨ Age
Breed Sex
Size: (Small: under 20 lbs., Medium: 20-50 lbs., Large: over 50 lbs.)
Current Rabies Vaccination Number:
Team: (Maximum 5 dogs per team, minimum 3 dogs to score.) List other members please.
Team Name
Do you wish to buy additional goodies?
Extra Short-Sleeve T-shirt at $12 each. Quantity $
T-shirt size(s)  XS* (  )     S (  )    M (  )    L (  )     XL (  )    XXL (  ) ($12)
*Will fit small-to-medium dog.
Limited Edition Long-Sleeve T-shirt at $15 each. Quantity $
Long-Sleeve T-shirt size(s) L (  )    XL (  )    XXL (  ) ($18)
Team entry: Yes (  ) No (  )      Please fill out special form at number assignment.
Name or theme of costume entry
Entry fee: $17 per dog, if registered before 4/24/00.                 $
Late Registration after 4/24/00 $22 per dog.  (Do Not Mail)        $
Voluntary Additional Donation to PALS or UGA Foundation for Sundown Surgery         $
                                                                      Total Amount Enclosed  $

Waiver Statement:  Entry not valid unless signed.  In consideration of acceptance of this entry, I the undersigned, do waive any and all claims for myself and my heirs against the Greater Atlanta Veterinary Medical Society, any sponsors, officials and volunteers of this event for any claim of injury or illness which may directly or indirectly result from my participation in the 2000 Atlanta Dog Jog, even though their liability may arise out of negligence or carelessness on their part.  I know that running a road race with my dog is a potentially hazardous activity.  I further state that my dog and I are in proper physical condition to participate in this event.  I hereby grant full permission to any and all of the foregoing to use my name and any photographs, videotapes, motion pictures, recordings or any other record of my participation in this event for any publicity and/or promotional purposes without obligation or liability to me.
Warning:  I understand that high heat and humidity can be extremely dangerous and that I will not overexert myself or my dog(s) under these conditions:

 

Signed Date

Parent or Guardian if under 18

Acknowledgment of Dog


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