Name
*
First Name
Last Name
Email
*
Phone
(###)
###
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Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Occupation (optional)
Typical work hours (optional)
Emergency contact phone
(###)
###
####
List other pets and their breeds
Will other family members participate in the training of your dog?
Dog's name
Breed
Date of birth
MM
DD
YYYY
Sex
Altered or intact
Weight (lbs)
How long have you had your dog?
List all sport or work training your dog participates in
What do you hope to accomplish with your dog?
Vet clinic name and phone number
Vet's name
First Name
Last Name
When was your dog’s last general check-up/annual exam?
MM
DD
YYYY
List any health issues noted during the exam
List all known surgical procedures the dog has had and the dates they were performed
List any past/current injuries the dog has had, even if not seen by a vet, and any treatments administered, including alternative treatments
List any other special health considerations
Has your dog ever been through a rehab program for treating an injury?
If yes, please provide details
If known, list any illnesses or injuries that are common in your breed
What food(s) is your dog currently being fed? (include treats)
How often do you feed your dog?
How much food per meal?
List any/all supplements your dog is taking
Please list any food intolerances/allergies your dog has
*
Describe how you provide exercise and play for your dog
What are the physical requirements in the various sports your dog participates in? How often do they participate?
Is there anything else you would like to tell me about your dog, its activities, and its relationship with you?
What prior training has your dog had? (basic obedience, sports specific, etc.)
Does your dog enjoy the work?
What method(s) do you use to train your dog?
List all indoor and outdoor activities you and your dog participate in
Describe your dog’s general temperament/personality
Describe your dog’s motivation/interest in different rewards (regular food, special or high-value treats, toys, etc.)
List any training equipment you use/have used with your dog (halti, pinch collar, choke collar, front clip harness, etc.)
Cardiovascular activities
Strength activities
Flexibility/massage
Balance/body awareness
Sports-specific training
Any areas of sports-specific training/general conditioning your dog struggles with
Any recent changes to your dog's performance:
Where do you feel improvement is needed?
What are your short-term fitness/conditioning goals for your dog?
What are your long-term fitness/conditioning goals for your dog?
What limitations do you have from a fitness standpoint (difficulty bending, can’t run, back issues, etc.)?
Describe all the space(s) you have available for conditioning activities (yard, fields, parks, etc.)
List all conditioning equipment (FitPAWS, treadmill, cavalettis, etc.) you currently have
Do you provide permission for the representatives of Syndicate Hounds to consult with my veterinarian in the development of this canine conditioning and fitness program?
Disclaimer
All information and activities in our fitness programs and courses are for informational and educational purposes only and are designed for sound, healthy dogs. Our canine conditioning instructor is NOT a veterinarian or rehab specialist and as such cannot and will not diagnose or treat illness, disease, injury, or any other canine physical or mental disorder. The instructor cannot and will not prescribe any treatments, pharmaceuticals, or supplements/remedies. Canine conditioning and fitness activities are not a substitute for veterinary care, exams, diagnoses, and treatment. There are some injuries and health conditions where conditioning/fitness/working activities are not recommended and could be detrimental to the dog. All dogs participating in conditioning, fitness, performance, sporting, or working activities should have veterinary clearance and approval to engage in these activities (including strength training, interval training, endurance training, balance work, stretching, and so on). While there is a wide variety of benefits to dogs engaging in conditioning and fitness programs, no results are guaranteed. Enrollment in a program is based on the results of this pre-assessment form and an in person assessment and is not guaranteed. Completion and signing of this form results in no obligation on the instructors part to take the dog and owner into a conditioning program. WAIVER/RELEASE OF LIABILITY RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND ASSUMPTION OF RISKS AGREEMENT (hereinafter referred to as the "Waiver Agreement") PLEASE READ ENTIRE DOCUMENT CAREFULLY!!! BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT. By signing this agreement, you acknowledge and agree that this Waiver Agreement is voluntary and knowingly entered into by you. Any reference to Syndicate Hounds in this Waiver Agreement includes its’ owners, employees, officers, agents, students, clients, and volunteers, and all other persons or entities acting in any capacity on their behalf. IN CONSIDERATION of you and/or your dog’s participation in Syndicate Hounds training, fitness training, by signing this Waiver Agreement, you acknowledge and agree to the following terms and conditions of the Waiver Agreement on behalf of yourself, your spouse, children, parents, heirs, assigns, personal representatives and estate. This document is a full release and indemnity agreement whereby you are agreeing to release and indemnify Syndicate Hounds from all risks, known and unknown/unanticipated risks, involving all activities carried out by Syndicate Hounds, which are related, arise out of, or are in any way connected with you and/or your dog’s participation in activities with Syndicate Hounds. These risks include, but are not limited to, the inherent risk associated with dogs and dog related activities, the risks associated with dog training and dog care, and human error and NEGLIGENCE. You and your dog will be engaged in activities involving, but not limited to, training sessions and fitness training. You agree to abide by all policies and procedures set out by Syndicate Hounds. Without limiting the generality of the foregoing: · You agree to abide with all rules and regulations and protocols as explained by Syndicate Hounds which includes, but is not limited to, the safe and proper usage of fitness and training techniques and equipment; You are informed and understand: · Certain activities that my dog may participate in during the training sessions or fitness training, involve risk and possible injury, including, but not limited to: o Exposure to parasites, viruses, and other medical conditions passed from dog-to-dog or person-to-dog; o Sprains, strains, bites and broken bones; o Fatigue, hotspots, dehydration, nicks, cuts or death. · You further understand that not each and every potential risk can be listed above. You are further informed and understand: · That there are risks involved with training animals, including dogs, as their behavior can be unpredictable; · That a dog may, at any time, without warning, move/jump up, forward, backward or sideways; · That these risks, and others risks, are inherent when participating in activities with Syndicate Hounds; · That there are other activities creating risks that may not be anticipated or controlled by Syndicate Hounds and further, that by signing this document you acknowledge that Syndicate Hounds has no duty to do so; · That all risks and activities in general can cause property damage, bodily and personal injuries, illnesses, and death to you, your dog or members of your family; · That despite pursuing the creation of a safe environment, Syndicate Hounds are not infallible and may, on occasion, be passively or actively NEGLIGENT (NEGLIGENT meaning, generally, a failure to exercise ordinary or reasonable care) in their duties and responsibilities to you and this NEGLIGENCE can cause property damage, bodily and personal injuries, illnesses, and death, including wrongful death, to your dog, you or members of your family; · That this Waiver Agreement releases Syndicate Hounds NEGLIGENCE, including, but not limited to, any and all actions, for property damage, any bodily and personal injury, illness, paralysis and death; Without limiting the foregoing, you further agree to release and forever discharge Syndicate Hounds from any claim whatsoever which arise or may hereafter arise on account of any first-aid treatment or other medical and/or veterinary services rendered in connection with an emergency. By signing and submitting this form, you hereby voluntarily release, forever discharge and agree to indemnify and hold harmless Syndicate Hounds and to waive any and all claims, demands or causes of action, for all liability for any loss, damage, expense or injury, including death, that you or your dog may suffer, or that your family, heirs, assigns, personal representatives and estate may suffer, as a result of you and/or your dog’s participation in group training sessions or dog fitness sessions or boarding, with respect to any cause whatsoever, including human error, NEGLIGENCE (whether passive or active), BREACH OF CONTRACT or a BREACH of ANY OTHER DUTY OF CARE owed under any legislation, including, but not limited to, the Occupiers Liability Act, RSO 1990, c.O.2. You further agree to hold harmless and defend and indemnify Syndicate Hounds from any and all liability to any third party resulting from your participation in training sessions and dog fitness training with Syndicate Hounds. By signing below and submitting this electronic form, you acknowledge that you have read and understood the Waiver Agreement and understand that you accept and assume all risks. You elect to participate in the activities offered by Syndicate Hounds despite the risks, both known and unknown.
Electronic signature
First Name
Last Name
Today's date
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