First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Cell Phone

Passengers Name

Phone Number:

Email Address:

If minor (under 18 years of age) an emergency contact must be listed. Please list full name and relationship to participant

Phone Number:

Number of Rider Registrations Per Hand. $30 per Rider*

Number of Passenger Registrations Per Hand. $5 Per Passenger*

Additional Donation to Dogs

Total is to be sent via PayPal after submitting this form. A PayPal account is not required. You can use a credit card to make this payment using the donation button at www.pawsoftomorrow.dog/ride. Please list total amount to be sent:*

Release Waiver: I, the undersigned(on my own behalf and on the behalf of my heirs, personal representatives successors, and assigns), for and in the consideration of the opportunity to participate in the 1st Annual Hog for the Dogs Ride, A Poker Run, release and hold harmless any sponsor, business, or person organizing or participating in the Poker Run, to be named “Released Parties”, from any and all claims and demands, rights and causes of action of any kind whatsoever which I now have or later may have against the “Released Parties” in any way resulting from, arising out of, or in conjunction with the performance of their duties and my participation in any said EVENTS. I understand that this means that I agree not to sue any or all of the “Released Parties” for any injury resulting to myself or my property arising from or in connection with the performance of their duties in sponsoring, planning, or conduction the events. I am experienced in and familiar with the operation of motorcycles and fully understand the risks and dangers inherent in motorcycling. I am voluntarily participating in the EVENTS, and any injury, including death, which I might sustain to my person and property as a result of my participation in the EVENTS, and any negligence (except willful neglect) on the part of any or all of the “Released Parties” in performing their duties. By signing this Release, I certify that I have real this release and fully understand it and that I am not relying on any statements or representations made by the “Released Parties”. Parent or legal guardian must sign if participant is under eighteen (18) years of age.*
Choose one: Agree Disagree

Rider: By entering my name and the current date, I certify that the information entered on this form is true and that I (we) agree to all of the conditions included.*

Passenger: By entering my name and the current date, I certify that the information entered on this form is true and that I (we) agree to all of the conditions included.