Name_____________________________________________

Address___________________________________________

Phone number ______________________________________

T shirt size_________________

Each participant should complete a separate form whether team or individual. Please pre-pay. Checks payable to HSKC.

Credit cards accepted at the shelter, if you wish to sponsor someone by credit card, call the shelter & give info & tell them who you are sponsoring. 410-778-3648 www.kenthumane.org/

Sponsor’s Name                           Address                      Donation

1._________________________________________________

2._________________________________________________

3._________________________________________________

4._________________________________________________

5._________________________________________________

6._________________________________________________

7._________________________________________________

8._________________________________________________

9._________________________________________________

10.________________________________________________

11.________________________________________________

12._________________________________________________

13._________________________________________________

14._________________________________________________

15._________________________________________________

I agree to participate in the Mutt Strut for animals.I acknowledge that I am physically able to undertake the walk and waive any claims that may arise out of the walk which the walker may assert against any parties associated with the walk. If under 18, the signature of a parent or guardian is required.

Humane Society of Kent County MD Inc.www.kenthumane.org/