Me & My Furry Best Friend Christmas Photo Shoot Event

First Name *

Last Name *

Date of birth *

Current Age *

Phone Number *

Email Address *

Address

City *

State *

Zip Code *

Are you a Gwinnett County resident?

Please select the county where you live *

Number of Guests Attending *

Number of Pets *

Type of Pet *

Please state other type of pet. *

How did you hear about this event? *

Please check each box to confirm: *

My pet is healthy and up to date on vaccinations (including rabies).

My pet will stay on a leash or in a secure carrier and under my control at all times.

I will clean up after my pet and keep the event space clean.

I give permission for photos and videos of me and my pet to be used by Gwinnett Medicare LLC™ for community and marketing purposes.

I accept full responsibility for my pet’s behavior and agree to release Gwinnett Medicare LLC and event partners from any liability.

I agree that by providing my phone number and email address to Gwinnett Medicare LLC, I may receive SMS messages and emails from Gwinnett Medicare LLC and/or Gwinnett Medicare LLC brokers and other staff.