5K-9 Dog Jog
Saturday, April 29th
9:00 am
Race Location: Dankwardt Pool Shelter House/Dog Park
Directions: Route will be marked through Dankwardt and Crapo Parks. Course will be open from 9am-11am
with each kilometer marked, and water and trash/clean up stations throughout.
Awards: Each participant will receive a tasty award!
Proceeds: Benefits the TRUTH Youth Group
Entry Cost information: $25 will include one T-Shirt and puppy bandana. Additional T-Shirts will be $10
each while additional bandanas are $5 each.
Guaranteed T-shirts to all full price paid participants who register before April 19th
Registration/Packet Pickup: Same-day registration and race packet pickup will be available starting at 8am
on April 29th in the Dankwardt Pool parking lot.
Other Information: Trash bags will be provided for clean-up. Owners are responsible for cleaning up after
their dogs!!!
Make Checks to: Ss John & Paul, Memo: Youth ministry Mail to: Religious Education, 700 Roosevelt Ave.
Burlington, IA 52601
Contact: Amanda Nichols, 319-400-4122
[email protected]
Website: Race forms are also available online at http://dmcountycatholic.org/landing-page under the youth
ministry tab or at bit.ly/burlington5k9
-----------------------detach here ----------------------5K9 ENTRY FORM 4/29/2017 PLEASE PRINT LEGIBLY
Name_____________________________________________ Sex____Age______
Address ____________________________________________________________
City, State Zip ________________________________________________________
Phone ___________________________ E-mail ___________________________
SHIRT SIZE (quantity)
SM ____ M ____ L ____ XL ____ 2X ____ 3X ____
Extra bandana(s): ________
Total Enclosed: $25 registration fee, $10 per extra shirt, $5 per extra bandana ________________
Waiver (MUST BE SIGNED)
In consideration of your accepting this entry, I, the below signed, intending to be legally bound, for myself, my heirs, my executors and administrators, waive and
release and any all rights and claims for damages I may have against the race, and sponsors and their representatives, successors and assigns for any and all
injuries suffered by me in said event. I attest that I will participate in this event as a footrace, that I am physically fit and sufficiently trained for the completion of this
event. I understand that this is a dog-friendly event and will take full responsibility for my pet(s) and for myself during the course of this event. I understand that
the TRUTH Youth Group is not responsible for the animals that are brought to this event by their owners or for any injuries or accidents that occur. Furthermore, I
hereby grant full permission to use my name and likeliness, as well as any photographs and any record of this event in which I may appear for any legitimate
purpose, including advertising and promotion.
Signature_________________________________________Date________
Parent or Guardian if under 18_____________________________________
No refunds will be issued for any reason