Fitness Program

Owner's Name

Email Address

Pet's Name

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Media Release - By submitting this form, I authorize Inspired Paws of Cookeville to use the following personal information: (1) My picture- including photographic, motion picture and electronic (video) images. (2) My voice- including sound and audio/video recordings. I hereby grant Inspired Paws of Cookeville the right to use, publish and reproduce, for all purposes, my name, pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the internet, and for exhibition, distribution, promotion, advertising, press conferences and in brochures and other printed media. This permission extends to all languages, media, formats and markets now known or hereafter devised. **Please note, this is REQUIRED for all virtual and in-board sessions. Your pet's likeness will be used now and in the future. Humans will not, without direct concent.***

The veterinarian who generally treats and cares for my pet is:*

Has your dog ever bit another human? Explain.

Is your pet on any medications or supplements?

Does your dog(s) have any known allergies or dietary restrictions?

List of other healthcare professionals used (i.e. veterinary chiropractor, CCRP, etc.)

Please check the boxes if your pet has any of the following:

Addison’s Disease

Arthritis

Decreased Hearing

Back/Neck Pain

Decreased Vision

Cancer

Heart Disease

Cushing’s Disease

Hypothyroidism

Has your pet had any surgeries, if so please explain.

Has your pet had a recent injury, if so please explain.

Do you feel like your dog is in pain, if so please explain.

What are your primary fitness goals?

Do you have any personal limitations that you want me to be aware of?

Describe dog’s current exercise per day. Include distance, time, type during the week.

What exercise equipment to you currently have at home?

What mental games do you engage in with your dog?

Please list the cues your dog knows (i.e. sit, down, stand, back, nose touch, etc.)

Please list the competitive sports your dog is involved in (i.e. agility, barn hunt, IPO, etc.)

I understand that my dog’s physical fitness program is individually tailored to me get the goals and objectives agreed upon by my dog’s personal Fitness Coach and me.(Required)

I understand that my dog’s exercise program will involve participation in several types of fitness activities. These activities will vary depending upon the objectives that my dog’s personal trainer and I establish. Activities may include: 1) aerobic activities including, but not limited to, the use of treadmills; 2) muscular endurance and strength building exercises including, but not limited to, the use of weights, resistance bands, calisthenics, and exercise equipment; 3) other activities select ed by my canine personal fitness trainer and agreed upon by me; and 4) selected physical fitness and body composition assessments.(Required)

I understand that no exercise program is without inherent risks regardless of the care taken by a canine personal trainer and that my dog’s personal safety cannot be guaranteed. I realize that when my dog is participating in any exercises, particularly those that induce cardiovascular stress, there is a slight chance of serious injury (e.g., cardiovascular accident) or catastrophic incident (e.g., death, paralysis). Likewise, I know that engaging in muscular endurance, strength building, and other fitness activities sometimes results in minor injuries (e.g., bruises, musculoskeletal strains, and sprains), or less frequently, more serious injuries (e.g., muscle tears, herniated disks), and rarely, catastrophic injury (e.g., death, paralysis).(Required)

I understand that a regular canine fitness and conditioning program has been shown to have definite benefits for Canine Total Health. I know that some of the benefits can include weight reduction (if needed), reduction of body fat, improvement of cardiovascular function, improved strength and muscular endurance, improved posture, speed, quickness, proprioception, power, balance, and flexibility.(Required)

I understand that it is my responsibility to 1) fully disclose any of my dog’s health issues or medications that are relevant to participation in a strenuous exercise program; 2) have my dog cease exercise and report promptly any unusual feelings (e.g., difficulty breathing, apparent injury, lameness, refusal to eat or work) during the exercise program; and 3) clear my dog’s participation in any canine fitness activity with my Veterinarian.(Required)

In agreeing to this canine personal fitness program:(Required)

• I acknowledge that my dog’s participation is by my decision
• I understand the potential physical risks involved in participating in an exercise program and believe that the potential benefits outweigh those risks.
• I give consent to certain physical touching that may be necessary to ensure proper technique and body posture.
• I understand that the achievement of health and/or fitness goals cannot be guaranteed.
• I have had a voice in planning and approving the activities selected for my dog’s training/exercise conditioning program.
• I have been able to ask questions regarding any concerns I might have and have had those questions answered to my satisfaction.
• My dog is in good and healthy physical condition, has no impairment which might prevent participation in such activities, and I have been advised to consult with a veterinarian prior to beginning this program.
• I have been advised to have my dog cease activity immediately if I see that m y dog is experiencing unusual discomfort and or if I feel the need to have m y dog stop the program. I have read and understand the above agreement; I have been able to ask questions regarding any concerns I might have; I have had those questions answered to my satisfaction; and I am freely acknowledging this agreement.

Fitness Program

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