2008 Leash-a-thon Entry Form
13th Annual Darcy's Pet Charity Leash-a-thon

PLEASE ENSURE INFORMATION IS FILLED OUT COMPLETELY
Owner’s Name: Suggested Local Charity:
Address: Postal Code:
Home Phone:

Work Phone:
Pet's Name: Species (Dog,Cat,Rat):
Date of Birth: Breed:              Male/Female:

Route that this pet will be entered in:    2KM______       5KM______

Please submit a separate application for each pet being entered, and attach to initial application.

 

Option 1  Basic Entry Fee ($10.00) $
Option 2  Sponsorship  CLICK HERE TO PRINT OUT YOUR SPONSOR SHEET (please attach to this form) $
Option 3  Donation Only (no entry) $

Commemorative T-Shirts and Bandanas

A. 1. ADULT Short Sleeve T-shirt  ($15.00 each)

    S______qty     M______qty    L______qty     XL______qty     XXL______qty
   

    2. ADULT Long Sleeve T-Shirt   ($22.00 each)

    S______qty     M______qty    L______qty     XL______qty     XXL______qty

$
B. 1. Child's Short Sleeve T-shirt   ($15.00 each)

    6/8________qty     10/12________qty    14/16________qty 
   

    2. Child's Long Sleeve T-shirt   ($22.00 each)

    6/8________qty     10/12________qty    14/16________qty 

$
C. Pet Bandana  $6.00 each _________qty $

Total Amount Paid or Collected (cheques payable to "Darcy's Pet Charity Leash-A-Thon")

 $

Waiver: In consideration of the acceptance of my entry, I myself, my executors, administrators and assignees, do hereby release and discharge the organizers, workers, and sponsors for all claims or actions, whatsoever in any manner arising or growing out of my and/or my pet’s participation in this charitable event. I attest and verify that I have full knowledge of the risk involved in this event.

___________________Date            ____________________________Signature

This charity Leash-a-thon is held in memory of "Darcy", "Bob" and "Kiwi".

Return form with entry fees by Mon. May 5th, 2008 by 4p.m. to:

Thunder Bay Veterinary Hospital, 920 Carrick St., Thunder Bay, ON P7B 7C6      623-3531

Office Use:      Source - Website 
Information Checked     Entered by:___    Paid by: Cash    Cheque 

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