MUTT MARCH PLEDGE FORM

September 17, 2012 at 6:38pm

                 

 MUTT MARCH PLEDGE FORM

 

PARTICIPANT’S NAME__________________________________________________

DEAR SPONSOR:  I am a student from _________________________________ School and my dog and I are participating in the Mutt March for the benefit of the Kalkaska Animal Shelter’s new building fund.  The event is being hosted by NorthWoods Animal Coalition, a 501(c)3 non-profit organization whose address is PO Box 1002, Kalkaska, MI  49646.

 

YOUR PLEDGE:  You may donate any amount to the Mutt March or you may donate an amount based on the Five Kilometer walk.  For example:  a contribution of $4 per kilometer equals a total of $20.  Checks may be made payable to NorthWoods Animal Coalition with a memo “Shelter Building Fund.”  Please give your donation to the above participant when contacted.

 

PLEDGE #1

 

NAME____________________________________________Amount$____________

 

City, State, Zip________________________________________________________

 

Email______________________________________Phone_____________________

 

 

PLEDGE #2

 

NAME____________________________________________Amount$____________

 

City, State, Zip________________________________________________________

 

Email______________________________________Phone_____________________

 

 

 

PLEDGE #3

 

NAME____________________________________________Amount$____________

 

City, State, Zip________________________________________________________

 

Email______________________________________Phone_____________________

 

 

PLEDGE #4

 

NAME____________________________________________Amount$____________

 

City, State, Zip________________________________________________________

 

Email_______________________________________Phone____________________

 

PLEDGE #5

 

NAME____________________________________________Amount$____________

 

City, State, Zip________________________________________________________

 

Email_______________________________________Phone____________________

 

If Participant(s) have more than 5 sponsors, please attach a separate sheet with name, pledge amount, address, city, state, zip, and phone number, and attached it to this form.

 

 

 

I agree to hold harmless the individuals hosting the Mutt March, its sponsors, all members of those organizations, individually, and NorthWoods Animal Coalition, Inc., from any accident, injury, or illness which I or my pet may incur during the Mutt March.  If I am signing for a minor, I give permission for my child to participate in the Mutt March.  I also attest that my pet is in good health and up-to-date on immunizations, and that my pet and I are physically fit to participate in the walk mentioned above.  I further grant permission for use of photos of me and my pet for publication purposes.

 

___________________________________________Dated____________________

(Print Name Here)

 

Parent’s signature required if participant is less than 18 years of age