print in portrait format if possible

Dog Jog 2012 Run/Walk

OFFICIAL ENTRY FORM

Name of Owner: _______________________________________

Name of Dog:_________________________________________

Address:______________________________________

City, State, Zip:_________________________________

Phone:________________________________________

email:____________________________________________

Sex of Owner:_____________

Race Division (circle one only):

2-Mile Run - Small Dog Division (15 pounds and under)

2-Mile Run - Medium Dog Division (16 - 39 pounds)

2-Mile Run - Large Dog Division (40 pounds and over)

1-Mile Fun Walk with your dog.

Entry Fee: (check only one)

________$25 Pre-registration (includes T-shirt)

________ $30 Race Day (T-shirts while supplies last)

T-Shirt size: (circle one) Youth and adult YM, YL, S, M, L, XL

Make checks payable to: "Friends of Noah"
Send to: Greg McCormick, 10119 Crosier Lane, Cincinnati, OH 45242
(Pre-registrations must be postmarked by Monday, October 1, 2012

WAIVER: In consideration of the acceptance of my entry, I hereby waive on behalf of my heirs, executors, and assigns, all claims of any nature arising from my participation in the Dog Jog and Barktoberfest and do hereby release Running Time LLC, The City of Cincinnati, Hamilton County Park Districe, Cincinnati Recreation Commission, the organizers and all sponsors, workers, officials, and volunteers from any claim whatsoever arising from my participation in this event. I agree to abide by all the rules for participation and acknowledge that the Race Committee may refuse or return my entry at its discretion. I understand that the risks for such a run/walk and have trained myself and my dog adequately in preparation. I have noted any relevant medical conditions on the back of this form. I permit the use of my name and picture participating in this event for publicity. My dog is currently licensed and up-to-date on Rabies and Distemper-Parvo vaccinations.

ENTRY SIGNATURE:____________________________________ Date: _________________

Parent's Signature (if under 18): ____________________________Date: ___________________

Emergency Contact:: ______________________________Phone________________________

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