Hogs for Dogs Dice Run

Pre Registration is now closed. We will see you tomorrow at Brickside at 10am!

Or print (word doc or PDF) & email, or bring to event.
If email please use director@hshcwv.org

hogs_for_dogs_2021_waiver_only_form.docx
File Size:	34 kb
File Type:	docx

Download File

2021_waiver_only.pdf
File Size:	68 kb
File Type:	pdf

Download File

Hogs for Dogs 2021 ONLINE Waiver Form

Must have a signature for each person- example if just single rider then one signature, if rider and passenger then two signatures, if passenger is under 18 the adult will need to sign twice.
Must have Name & Address for each person.

Hogs for Dogs 2021 Waiver Form
In consideration of the Humane Society of Harrison County, Inc (“HSHC”) planning and conducting the Annual Hogs for Dogs Dice Run, I, for myself, my heirs, executors, administrators and personal representatives, do hereby agree to release, indemnify and hold harmless the Humane Society of Harrison County, its officers, trustees, employees, volunteers, corporate sponsors, cooperating organizations, and any other parties connected with this event in any way, including Brickside Bar & Grille & participating locations, from and against any loss or liability for any injury, harm, loss, inconvenience, exposure to Coronavirus (COVID 19) or any other damage of any kind which may result from or be connected in any way to my participation in the Hogs for Dogs Dice Run on June 19, 2021. In addition to releasing the Humane Society of Harrison County, Inc., I hereby certify that I am physically capable of participating in this event, that I will conduct myself in a prudent manner, including obeying all traffic laws at all times during said event, and that I have a valid West Virginia driver’s license with a motorcycle endorsement, or a similar valid motorcycle operator’s permit from the state in which I am a resident.

CoViD-19 Disclaimer: If you are sick or feeling you are getting sick, we ask that you please stay home. Currently, older adults and persons with underlying health conditions are considered to be at increased risk of severe illness and complications from COVID-19. Examples of underlying health conditions include heart disease, lung disease, diabetes, people with weakened immune systems, and people who are pregnant. The CDC recommends that people in high-risk groups consult with their healthcare provider about attending any large gathering.

I grant the HSHC permission to use my name, photograph, digital image, video image and/or other digital reproduction of me or my likeness for any reasonable purpose, whether electronic, print, digital or electronic publishing via the Internet or any other form of media.
I have read this waiver release and understand its terms.
Please sign below: 

* Indicates required field

Rider Please Sign in Box *

Passenger or Under 18 Please sign in box *

Date *

Email *

Rider Name *

First

Last

Date of birth including year *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Passenger Name *