REGISTRATION FORM FOR WIGGLE WAGGLE WALK FOR WILDLIFE

 Print, fill in and mail to:  8707 W. Dameier Rd. Lena, IL 61048.

ONE FORM PER WALKER, PLEASE.  You can duplicate this form for friends and family.  (If you are not able to attend the Wiggle Waggle Walk

but wish to make a contribution, please use the contributions form only.)

Please print:

Name: ______________________________________________________________________________

Companion’s name: ___________________________________________________________________

Phone: _______________________________________

Address:____________________________________________________________________

City: _____________________________________ State:_______ ______ Zip: _________________

Email: ___________________________________________

Registration/contribution is $20 for registered walker and companion. 

You receive an AGC Animal Sanctuary water bottle, t-shirt and free meal at the event.   

All walkers will be required to sign a liability waiver at check-in on the day of the event.

Let everyone know that they are welcome to come to Le-Aqua-Na on October 7^th from 9am till 2pm for fun and food. 

We will have several fundraisers being displayed with a wonderful lunch, free to all who participate. 

All proceeds benefit the animals at the sanctuary, we have no paid employees.

SOCIAL CONDUCT CONTRACT:  So that our event will be enjoyable for all, please abide by these guidelines.

*No extendable leashes please.  Leashes should be no longer than 6 feet.

*Licensed and vaccinations should be current on all dogs participating.

*Your companion should be well behaved around others.

*Not in heat.

*Under your control at all times.

*If your companion messes, it is your responsibility to clean up after him or her.

Thank you for abiding by these guidelines and participating in the WIGGLE WAGGLE WALK for Wildlife.

A community bowl will be available for your companion and there will be Bar-B-Q, Chips and Drink for all participants

and available for purchase by others.