Pledge Form

COCHECO VALLEY HUMANE SOCIETY

2001 Walk-A-Doggie-Thon Pledge Walk for Homeless Animals

Human's Name______________________________ Age_____

Pet's Name_____________________________
Team (if applicable)___________________Organization _____________________
Home Address________________________ City____________ State______ Zip________
Day Telephone _______________________ Evening Telephone_______________ Fax__________________

IMPORTANT: Check here to enter for individual prizes if you are registering on a team E-mail______________

The team turning in the most pledges* will receive a special plaque and team prize. The top individual pledge collector will capture the grand prize "Doggie Day Out" in a stretch limousine. Your pet will be treated like royalty at the groomer, chauffeured to a professional photo sitting, and taken on a pet shopping spree!

Date: Sunday, June 10, 2001. Rain or Shine. Registration for Fun Dog Show begins at 10:30AM. Lunch available.
Blessing of the animals is before walk at 1:00PM on the Cathy Schiro O'Brien Cross Country Trail. Sponsors should base pledges on the entire walk as this is not a multi-mile event. Entry fee waived with $100 or more in pledges. Receive a tee shirt with $75 or more in pledges. Dogs must be leashed and licensed with vaccinations current. Females must not be in heat. Sorry, no cats or small animals.

Name of Pledger		Address/City/State/Zip	Daytime Phone	Contribution	Employer Match
	Mr. "Pup" E. Dawg	8 Chuck Wagon Way	555-1234	$25.00	$25.00
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		Total Pledges*
		Total Employer Matches
		Total Collected for the Animals
Thanks to our sponsors and to you! Why not enter your adopted cat or rabbit in the "Paw Prints Photo Fest?" Your little friend will be there in spirit when you enter a photo of your favorite feline or rabbit for the photo collage to be displayed at the walk. Print your and your pet's full name, complete address, and telephone on the back of a 3" x 5" or 4" x 6" photo of your adopted cat or rabbit including a check for $5 per photo. Mail to Attn: Paw Prints Photo Fest, C.V.H.S., 262 County Farm Road, Dover NH 03820. Entries must be postmarked no later than Friday May 25th. "Honey Bunny" and "Cat's Meow" will be announced at the walk. One photo per pet. Up to two entries per household. Photos will not be returned by mail. E-mail or faxes of photos are not considered entries. ______ $10 Entry fee (waived with $100 or more in pledges turned in) Rabies Tag Number:_____________________ Waiver: I, and on behalf of my heirs, successors, and assigns, assume any and all risks associated with the Walk-A-Doggie-Thon and Fun Dog Show, and waive and release any and all rights and claims against Cocheco Valley Humane Society, its agents and representatives, and any others connected with the event for injuries and damages of any kind suffered by myself or my animal. I grant permission to any and all use of photographs, motion pictures, videotapes or any records to CVHS. ______________________________________________________________________ ___/___/___ Registrant's signature, parent or legal guardian must sign if under 18 Print name Date Please use extra pages to collect additional pledges! Walk with or without a dog. For more information, contact the walk coordinator at or call . Prizes are subject to change and are not redeemable for cash. Doggie Day Out to be completed by July 20, 2001. If you would like to be eligible for prizes, but do not plan to attend, please mail check payable to CVHS for the total amount collected postmarked no later than 6/6/01 to Cocheco Valley Humane Society, Attn: Walk Coordinator, 03820. Your contribution is tax deductible to the full extent of the law. Your cancelled check is your receipt. *Prizes awarded are based on total pledges (employer match not included) turned in on or prior to 6/10/01 at 12:45PM.