Name

Address

City

State

Zip

Telephone

Email address

Company You Work For

Age on day of race

Date of Birth

Male or Female

Chip Number (This is for runners who own their own chip)

8K Run or 3K Dog Jog (You are welcome to participate in the 3K without a dog)

How did you hear about the Dog Jog

Dog Participating  (only allowed in the 3K Dog Jog)

Shirt Sizes ( XS, S, M, L, XL) or write in "no shirt" - For Example (1-XL and 1-M)

3K Dog Jog only - Please list the names and ages of children under 12 who are participating

Please mark YES or NO - I have a disability for which I am requesting an accommodation.  I will visit www.usatf.org and follow all applicable requirements to obtain consideration.  It generally takes 6 weeks from the receipt of all relevant documentation to evaluate a request.

In consideration of my participation in the A New Leash On Life, Inc. 8K Run or 3K Dog Jog, I do hereby for myself, my heirs, my executors, administrators, and assigns release and discharge A New Leash On Life, Inc., DG Productions & other sponsors and officials for all claims of damages, demands, actions whatsoever in any manner arising or growing out of my participation in this event. This release and waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. The undersigned grants permission to sponsors and or agents authorized by them to use any photos, videotapes, motion pictures, or any other record of this event for any purpose. I attest and verify that I have full knowledge of the risks involved in this event and I am medically able and properly trained to participate in this event. 

(Parent or Guardian signs if participant is under 18).

Please indicate your acceptance of this waiver by typing "I accept" below:

Race Participation (8K or 3K)- including shirt ($20) Race Participation (8K or 3K)- no shirt ($15) Extra T-shirt ($5) Extra T-shirt ($5) Extra T-shirt ($5) Extra T-shirt ($5) Extra T-shirt ($5) Extra T-shirt ($5) Extra T-shirt ($5)

Important!!!  You must print out this page or remember your total.  You will need to re-enter it on the PayPal payment page.  If your total charged is not the same as your registration page, your registration will not be complete.  You do not need a special PayPal account to pay on-line.  PayPal processes our payments so if you already have a PayPal account, you can sign in to PayPal.  If you don't use PayPal, just look for the BOLD type that says Don't have a PayPal account? and click the continue button. Thank you for supporting A New Leash On Life, Inc.! Total