Indian
Hills
Animal
Clinic
DOG
JOG
INDIAN HILLS
ANIMAL CLINIC
1448 N. Maize Rd
Wichita, KS 67212
316-722-6444
3223 W. 13th St. N.
Wichita, KS 67203
316-942-3900
n
Saturday, April 22, 2017
A Fundraising Event to Benefit the Kansas Humane Society
8:00am * 5k run 9:30am * 1.5 mile Wag-n-Walk Sedgwick County Park
How
to
Enter
Entry
Form
Please complete a separate entry form for all human participants
Name: ________________________
Address: ______________________
City: _________________________
State __________ Zip __________
Phone ______________ Age _____
E-mail ________________________
5k Dog-N-Jog
Gender:
male
Shirt Size: S M
female
L XL 2XL 3XL
Dog(s) Name: ________________________
Where did you hear about us? ____________
1.5 mile Walk-N-Wag
Katie’s Tail Chaser Combo
In consideration of your acceptance of this entry, I hereby, for myself, my heirs, my executors and administrators, waive any and all
rights and claims for damages I may have against sponsors, coordinating groups, and any individuals associated with the event, their
representatives, successors and assigns for any and all injuries suffered by me in connection with said event. Also, none of the above
are responsible for the loss of personal items nor any other form of aggravation in connection with said event. My dog(s) must be
current on all vaccinations. In filling out this form, I acknowledge that I am an amateur in such events. I also give my persmission
for the free use of my name and picture in any broadcast, telecast or print media account of this event. In filling out this form I
acknowledge I have read and fully understand my own liability and do accept the restrictions.
Signature of participant ______________________________________ If under 18, signature of parent or guardian: ________________________
How to Register
Entry Fees: (Age 13+)
* Entries received by 4/21/17:
* $25 for 5k Dog-N-Jog
* $25 for 1.5 mile Walk-N-Wag
* $50 Tail Chaser Combo (both races & additional medal)
* Day-of Race registration is additional $5 per race.
Entry Fees: (Age 12 & below)
* $20 for 5k Dog-N-Jog
* $20 for 1.5 mile Walk-N-Wag
* $40 Tail Chaser Combo (both races & additional medal)
* Day-of Race registration is additional $5 per race.
Please send entry from and payment to:
Dog-N-Jog
Indian Hills Animal Clinic
3223 W. 13th St. N
Wichita, KS 67203
Make checks payable to: Dog-N-Jog
Or register online at: www.dognjogwichita.com
Race packets will be available for pick-up on 4/21/17 from 4:00-7:00 pm at Indian Hills Animal Clinic:
3223 W. 13th St. N 67203 and at Sedgwick County Park on the morning of the race.
We will do everything we can to guarantee all participants a t-shirt. Entry fees put towards KHS donation.
Proceeds Benefit
The Kansas Humane Society is a private, non-profit organization that receives nearly
18,000 animals each year. Many of those pets need nothing more than a little love,
quality care and a second chance. KHS specializes in those second chances by
providing quality adoption services and making the best match possible between the
adoptable pets and their potential new families. The Kansas Humane Society receives
no local or state tax dollars, United Way funding, or support from the Humane Society
of the United States. They rely on private donations and adoption fees.