NCCR'S 1st Annual Walk & Wag
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Name: *
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Address: *
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Phone #: *
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Pet's name: *
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Release: In signing this release, I acknowledge that I understand the intent thereof and I hereby agree and will absolve and hold harmless Northern Chautauqua Canine Rescue Inc., Lake Erie State Park, and any other parties connected with this event in any way, singly or collectively, from and against any blame and liability for any injury, harm, loss, inconvenience or damage hereby suffered or sustained as a result of participation in the NCCR Walk and Wag or any activities associated herewith. I hereby consent to and permit emergency treatment in the event of injury or illness. I give full permission for use of my name and photograph in connection with this event. I also agree to keep my canine companion on a leash and under control at all times.
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Signature & Date: *
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Parent/Guardian (if under 18) *
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