Waiver

Please print and complete this Waiver and bring with you on September 2, 2012. If you do not have access to a printer, we will have a supply of waivers available at the event and would be pleased to provide one to you.

RELEASE AND INDEMNITY TO:

The Participant set forth below.

We understand that you (the “Participant”) would like to participate in the Pooch Plunge event (the “Event”) to be held on Sunday September 2nd, 2012. Please know that (London Dog Owners Association) (together, the Sponsors”) are unable to and do not accept any liability or responsibility whatsoever for any damages or injuries sustained by you or your dog while attending the Event, whether occasioned by the conduct of others dogs their owners or otherwise. By signing below, and in consideration of our allowing you and your dog to attend and participate in the Event, you herebya) release the Sponsors from liability whatsoever in respect of any damages or injuries which you or your dog may suffer while attending or participating in the Event; and (b) agree to indemnify and hold the Sponsors harmless from all claims, damages or injuries arising out of any act occasioned by you or your pet. Please know that the Sponsors reserve the right to remove any persons or dogs from the Event for any behaviour, which the Sponsors as provided for above, by signing below you, additionally and specifically, agree as follows:

I, __________________________________, hereby release the Sponsors from (and acknowledge and agree that the Sponsors accept no responsibility whatsoever for) any and all claims I may have for any damages or injuries resulting from or during my and/or my dog’s participation in the Event, however occasioned, including, without limitation, if occasioned by the conduct or actions of any persons or dogs who may also be participating in or organizing the Event. Also I accept full responsibility for my conduct and that of my dog at all times and hereby agree to indemnify and hold the Sponsors harmless, from any or all claims, damages or injuries which they may suffer or incur, whether directly or indirectly, as a result of me or my dog’s actions and/or participation in the Event. This includes any liability for damages suffered by others because of any conduct or action by my dog or myself.

We hope you enjoy the Event.

Sincerely,

London Dog Owners Association, the City of London

Signature of Owner/Guardian: _____________________________________________
Date: ____________________________
Print Name :( First) ____________________________
(Last) _________________________________
Address: _____________________________________________________________
Phone Number: _______________________________
Dog’s Name: ___________________________
Dog License Number: ____________________
Rabies Tag: ____________________________
(PAID $5.00 per Plunge) Amount paid: _______________
Session One_____ Two ______ Three ____