KENTUCIANA PUG RESCUE, INC. RELEASE FOR PARTICIPATION IN FUNDRAISING EVENT Event: Kentuckiana Pug Rescue “2008 500 Pug Festival!” Date: August 2, 2008 Location: Lebanon IN , Boone County Fairgrounds Community Bldg

The top half of this form must be completed by each adult participating in the event. Parents and legal guardians of children under 18 years of age participating in the event must complete the bottom portion also.

I agree that when I, my family (if any), children under my care (if any), and my pets (if any) participate in the Event stated above, I/we/they do so at their own risk. In consideration of your permitting me/us/them to participate in the Event, and for other good and valuable consideration, receipt of which is hereby acknowledged, I hereby release and forever hold harmless Kentuckiana Pug Rescue Inc., it’s directors, officers, agents, and volunteers and it’s heirs, successors, assigns and personal representatives, from any liabilities, losses, costs, expenses, damages or injuries whatsoever, which I, my family, children under my care, and/or pets incur or sustain in connection with the Event.

________________________________________________________________ Printed Name ________________________________________________________________ Signature ________________________________________________________________ Address/City/State/Zip ________________________________________________________________ Telephone Number ______________________________@________________________________ E-mail How many pugs did you bring to this event? __________

If your children, under age 18 are participating in the Event state above, please complete the following section. I am the parent/legal guardian of the child(ren) below, and I give my permission for this/them child(ren) to participate in the Event. _______________________________________________________________ _______________________________________________________________ Child(ren)'s Name(s) ______________________________________________________ Parent/Guardian Signature