Please print this form from your browser, complete and mail with payment to address below.
Entry Form
Please complete a separate entry form for each human participant.
Name: ______________________________________________________________________________________________________________________________________
( First and Last )
Address: _____________________________________________________________________________________________________________________________________
City: __________________________________________________________________________________________________________________________________________
State: _________________________________________________________________________________________________________________________________________
Zip: ___________________________________________________________________________________________________________________________________________
Phone: ________________________________________________________________________________________________________________________________________
Email: _________________________________________________________________________________________________________________________________________
Participant’s Age: _____________________________________________________________________________________________________________________________
Participant’s Gender: Male or Female
Dog’s Name: __________________________________________________________________________________________________________________________________
Event(s) for which you’re registering please check one:
_____1.5K race
_____ 5K race
_____ Family Fun Run (Park Circuit)
Entry Fee: $10 per race
Payable by check or cash only. Include payment with your registration form.
2014 Paws for a Cause T-shirts
T-shirts are available for $16 each.
ALL T-SHIRT ORDERS WITH PAYMENT MUST BE RECEIVED BY JUNE 14th. If payment has not been received by June 14, your t-shirt will not be ordered.
Please write the quantity of each needed shirt size beside the options below.
(kids sizes) ___S ___M ___L ___XL
(adult sizes) ___S ___M ___L ___XL ___2XL ___3XL
Qty ______ x $16 each = __________________
Payable by check or cash only. Include payment with your registration form. you
In consideration of your acceptance of this entry, I hereby, for myself, my heirs, my executors and administrators, waive any and all rights and claims for damages I may have against sponsors, coordinating groups, and any individuals associated with the event, their representatives, successors and assigns for any and all injuries suffered by me in connection with said event. Also, none of the above are responsible for the loss of personal items nor any other form of aggravation in connection with said event. I have been notified by this form that I and my dog(s) must be in good health to participate in this event. My dog(s) must be current on all vaccinations. I understand that unruly or aggressive dogs may be asked to leave the event. In filling out this form, I acknowledge that I am an amateur in such events. I also give my permission for the free use of my name and picture in any broadcast, telecast or print media account of this event. By my signature below I acknowledge I have read and fully understand my own liability and do accept the restrictions.
_________________________________________________________________________________________________________________________________________________
Signature of Participant
(or Parent if participant is under the age of 18)
Mail completed form along with payment to:
Megan Ritter
13616 Walnut Creek Road
Randolph KS
66554
Please complete a separate entry form for each human participant.
Name: ______________________________________________________________________________________________________________________________________
( First and Last )
Address: _____________________________________________________________________________________________________________________________________
City: __________________________________________________________________________________________________________________________________________
State: _________________________________________________________________________________________________________________________________________
Zip: ___________________________________________________________________________________________________________________________________________
Phone: ________________________________________________________________________________________________________________________________________
Email: _________________________________________________________________________________________________________________________________________
Participant’s Age: _____________________________________________________________________________________________________________________________
Participant’s Gender: Male or Female
Dog’s Name: __________________________________________________________________________________________________________________________________
Event(s) for which you’re registering please check one:
_____1.5K race
_____ 5K race
_____ Family Fun Run (Park Circuit)
Entry Fee: $10 per race
Payable by check or cash only. Include payment with your registration form.
2014 Paws for a Cause T-shirts
T-shirts are available for $16 each.
ALL T-SHIRT ORDERS WITH PAYMENT MUST BE RECEIVED BY JUNE 14th. If payment has not been received by June 14, your t-shirt will not be ordered.
Please write the quantity of each needed shirt size beside the options below.
(kids sizes) ___S ___M ___L ___XL
(adult sizes) ___S ___M ___L ___XL ___2XL ___3XL
Qty ______ x $16 each = __________________
Payable by check or cash only. Include payment with your registration form. you
In consideration of your acceptance of this entry, I hereby, for myself, my heirs, my executors and administrators, waive any and all rights and claims for damages I may have against sponsors, coordinating groups, and any individuals associated with the event, their representatives, successors and assigns for any and all injuries suffered by me in connection with said event. Also, none of the above are responsible for the loss of personal items nor any other form of aggravation in connection with said event. I have been notified by this form that I and my dog(s) must be in good health to participate in this event. My dog(s) must be current on all vaccinations. I understand that unruly or aggressive dogs may be asked to leave the event. In filling out this form, I acknowledge that I am an amateur in such events. I also give my permission for the free use of my name and picture in any broadcast, telecast or print media account of this event. By my signature below I acknowledge I have read and fully understand my own liability and do accept the restrictions.
_________________________________________________________________________________________________________________________________________________
Signature of Participant
(or Parent if participant is under the age of 18)
Mail completed form along with payment to:
Megan Ritter
13616 Walnut Creek Road
Randolph KS
66554