Home » Book Run Book Run Client InformationFirst Name(Required)Last Name(Required)Address(Required) Street Address City ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Email Address(Required) Phone(Required)Service Goals & Scheduling What are the goals you have for your dog? (Check all that apply)(Required) Weight loss Conditioning improvement Injury rehabilitation Senior dog mobility Confidence building Anxiety reduction Reactivity or aggression issues Socialization General fitness Enrichment How often do you plan to exercise your dog?(Required) 1 to 2 times weekly (recommended) Every other week Unsure What kind of sessions are you seeking?(Required) Regular and consistent routine Occasional sessions to tire out my dog Desired session days (check all that apply)(Required) Monday Tuesday Wednesday Thursday Friday Saturday Desired session time(Required) Morning (7AM-10AM) Afternoon (11AM-4PM) Evening (5PM-7PM) Pet InformationPet #1 (Required)Pet #1 Name(Required)Has pet #1 had their rabies vaccination?(Required) Yes No Pet #1 Rabies Expiration Date(Required) MM slash DD slash YYYY Pet #1 Sex(Required)Pet #1 Weight(Required)Pet #1 Breed(Required)Pet #1 Birthday(Required) MM slash DD slash YYYY (Approximate if unknown)Pet #1 PictureMax. file size: 1 GB. Pet #2 (Optional) Pet #2 NameHas pet #2 had their rabies vaccination? Yes No Pet #2 Rabies Expiration Date MM slash DD slash YYYY Pet #2 SexPet #2 WeightPet #2 BreedPet #2 Birthday MM slash DD slash YYYY (Approximate if unknown)Pet #2 PictureMax. file size: 1 GB. Pet #3 (Optional) Pet #3 NameHas pet #3 had their rabies vaccination? Yes No Pet #3 Rabies Expiration Date MM slash DD slash YYYY Pet #3 SexPet #3 WeightPet #3 BreedPet #3 Birthday MM slash DD slash YYYY (Approximate if unknown)Pet #3 PictureMax. file size: 1 GB. Pet #4 (Optional) Pet #4 NameHas pet #4 had their rabies vaccination? Yes No Pet #4 Rabies Expiration Date MM slash DD slash YYYY Pet #4 SexPet #4 WeightPet #4 BreedPet #4 Birthday MM slash DD slash YYYY (Approximate if unknown)Pet #4 PictureMax. file size: 1 GB. Veterinary & Health Information Vet Clinic(Required)Vet Clinic Phone Number(Required)Does your dog have any health restrictions?(Required) Yes No If so, please List Injuries Or Restrictions(Required) Has your dog ever shown aggressive behaviors toward other dogs or people?(Required) Yes No Does your dog need to be muzzled?(Required) Yes No Does your dog have any allergies to treats?(Required) Yes No Do you consent to your dog receiving treats during his/her training session?(Required) Yes No Do you consent to your dog receiving water during his/her training sessions?(Required) Yes No Has your dog ever used a treadmill before?(Required) Yes No Waiver and Release of Liability (Rewritten) WAIVER AND RELEASE OF LIABILITY (Rewritten) I, the undersigned ("Client"), am requesting services from GOPAWZ (the "Company") for my dog(s). I understand and agree that working with dogs-including treadmill exercise, conditioning, handling, training, and related activitiesinvolves inherent risks that may result in injury, illness, death, or property damage, even when reasonable care is used. Please read and check each box: Health, vaccinations, and preventative care(Required)I represent and certify that my dog(s) is/are in good health and has/have been deemed suitable for treadmill walking/running and related exercise. I further certify that my dog(s) is/are current on required vaccinations, including DHLPP, Rabies, and Bordetella, is/are on appropriate flea/tick preventative, and has/have not had any known contagious illness within the past 30 days. Yes Acknowledgment of illness risk.(Required)I understand that vaccinations and preventative measures reduce risk but do not eliminate it. If my dog becomes ill or is exposed to a contagious disease, I agree that the Company is not responsible for diagnosis, treatment, or veterinary costs, and that I am solely responsible for my dog's care. Yes Photo/video consent and use.(Required)I give permission for my dog(s) to be photographed, videotaped, and/or recorded during sessions. I understand the Company may use such media for business purposes, including posting on GOPAWZ websites and social media. Yes Cancellation and no-show policy.(Required)I understand and agree that the Company will charge a $25 fee for appointments canceled with less than 48 hours' notice, and may charge the cost of one (1) full appointment for cancellations made with less than 24 hours' notice (including no-shows). I understand the Company may decline to schedule future appointments for repeated cancellations or until any outstanding balances are paid. Yes Assumption of risk; release; waiver; indemnification.(Required)I knowingly and voluntarily assume all risks associated with my dog's participation in the Company's services, including risks of injury, illness, death, and property damage, whether caused by my dog, other animals, third parties, equipment, the environment, or the acts or omissions (including negligence to the extent permitted by law) of the Company. To the fullest extent permitted by law, I hereby waive, release, and discharge GOPAWZ and its owners, officers, employees, contractors, agents, representatives, affiliates, successors, and assigns (collectively, the "Released Parties") from any and all claims, demands, causes of action, damages, losses, liabilities, or expenses arising out of or related to the services provided, including but not limited to claims for personal injury, property damage, illness, disability, or death, whether arising from negligence or otherwise. I further agree to defend, indemnify, and hold harmless the Released Parties from and against any claims, losses, damages, liabilities, costs, and expenses (including reasonable attorneys' fees) arising out of or related to (i) my dog's behavior; (ii) my breach of this Waiver; or (iii) my acts or omissions in connection with the services. Yes Entire agreement; severability.(Required)I understand that this Waiver is the entire agreement regarding risk, liability, and related matters for these services, and it supersedes all prior discussions or agreements on those topics. If any portion of this Waiver is found unenforceable, the remaining portions will remain in full force and effect. Yes Governing law; venue.(Required)This Waiver and any dispute arising from it or the services provided will be governed by the laws of the State of New York, with venue in Orange County, New York, unless applicable law requires otherwise. Yes Signature Date MM slash DD slash YYYY SignatureType legal name into box above to serve as signature Δ