Dawson County Humane Society
Dog Walk-A-Thon
April 26, 2009 at Rock Creek Park
Sponsor Name	Address	City	State	Zip Code	E-mail Address	Donation Amount
					Total Amount of Donations:
Walker's Name:
Complete Address:				"I release the officials, sponsors, volunteers, employees or anyone connected with the DCHS from all claims of injury or damage resulting from the participation in the Dog Walk-A-Thon. I also certify I am in proper physical condition to participate in this event." I release the officials, sponsors, volunteers, employees or anyone connected with the DCHS from all claims of injury or damage resulting from the participation in the Dog Walk-A-Thon. I also certify I am in proper physical condition to participate in this event.
Number of Dogs Walking & Their Names:				Date:
Team Name (If Applicable):				Signature:
T-Shirt Size if over $100 Raised				Parent's Signature if Under 18: