Sandy Paws Registration | Clean Ocean Action

$35 donation per dog:

I am unable to support or attend the event, but would like to make a donation of:

Owner Name: Dog Name (if applicable):

Dog Bandana Size:

Small Medium Large

Team (if applicable): Location:

Billing Information

First Name:

Last Name:

Address:

City:

Country:

State:

Zip:

Email:

Credit Card

Card Type:

Card Number:

Expiration Date:

CVV: ()

I acknowledge that I have voluntarily applied for the event organized by Clean Ocean Action, Inc. ("COA"), a nonprofit organization, designated as "Sandy Paws" ("Event") on Saturday, October 10th , 2015.

I understand that this Event involves physical activity and appreciate the risks, to my person and my participating dog(s), including serious injury and death, involved with undertaking such activity. I am prepared to assume the risks associated with this Event, including, without limitation, physical exertion, equipment malfunction, accidents, forces of nature, and the actions of persons without affiliation to COA or this Event.

I agree to take full responsibility for my own actions, safety and welfare as well as the actions, safety and welfare of my participating dog. I also understand that my participating dog and I will be members of a group and will conduct ourselves in a way that will not endanger the group, other dogs, or ourselves. I represent that my dog and I are physically fit for this Event; if this is not so, my dog and I may be removed prior to or during the Event without recourse against COA.

I represent that my dog has all current rabies vaccinations and is up to date on all shots. I also understand that there will be other dogs at this event and that my dog must not be aggressive to other humans or dogs.

I further hereby release and discharge COA, and its agents, employees, volunteers, and equipment suppliers from and against any and all liability, including for any losses, damages or injuries, arising from my participation in the Event. I agree that this release will be legally binding upon me, my heirs, successors, assigns and legal representatives; it being my intention to fully assume all risk of the Event and to release COA from any and all liabilities to the maximum permitted by law.

I grant full permission for COA, the City of Asbury Park, and Event Sponsors to use photographs, videotapes, motion pictures, recordings or any other record from this Event, including those in which my dog, child or I appear.

BY AFFIXING MY SIGNATURE TO THIS FORM, I ACKNOWLEDGE THAT I HAVE READ AND CONSENT TO THE ABOVE.

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