National Dog Walk Signup Form

Your financial details are not stored on our database and your contact details will not be shared with 3rd parties.

Fields Marked * are Mandatory

At which Centre will you be walking*
Registration Type	Individual €5 Family (up to 4 people and/or 4 dogs) €10
Your Dog(s)
Dog 1.	Dog's Name
Dog 1.	Breed
Dog 2.	Dog's Name
Dog 2.	Breed
Dog 3.	Dog's Name
Dog 3.	Breed
Dog 4.	Dog's Name
Dog 4.	Breed
Your Details
Title*
Firstname*
Surname*
Address1*
Address2*
Address3
Address4
County*
Tel/Mobile (Home)
Tel/Mobile (Work)
e-Mail Address*
Name of Other Participants (Family group ONLY)	1: 2: 3:
I'd like to make an additional donation of	Not this time €25 €50 €100 Other € (whole numbers only please)
	Keep in touch now and again to let me know what The Carers Association is doing.
	To ensure the welfare and safety of all people and dogs participating in this walk, I/we accept responsibility for our dog(s) for its duration. I/we agree to keep my/our dog(s) on their leash for the duration, that they will wear a muzzle if required, and dog waste will be correctly disposed of. I/we hereby confirm that I/we are taking part at my/our own personal risk and release all rights and claims for damages I/we may incur against The Carers Association.*

Your dog is our hero! Your four legged friend is walking for a great cause, why not encourage your network to sponsor your dog by creating a page for him or her on mycharity.ie

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The Carers Association

National Dog Walk Signup Form