CRCG Liability Agreement

Please reply with answers to the following questions prior to your first appointment. Sending us this information prior to your appointment will allow more time dedicated to the exam, treatment planning, and answering any of your questions.

Client Information

Client Name*

First Last

Pet Information

Pet Name*

Liability Agreement:

Please select the checkboxes to indicate you have read and understood the information provided.

I understand and agree that in admitting my dog to the use of its facility, CRCG has relied on my representation that my dog is in good health or I have disclosed any known health issues.

I have documented any issues in the past of harm, aggression or threatening behavior towards any person or any other dog.

I understand and agree that the staff of CRCG is not engaged in the practice of general veterinary medicine.

I understand and agree that CRCG, its staff and volunteers, will not be liable for any problems that arise out of my or my dog’s use of CRCG’s facilities and I hereby release them from liability of any kind whatsoever in regards to my dog(s) attendance and participation at CRCG.

I understand that I am solely responsible for any harm caused by my dog(s) while my dog is utilizing the facilities of CRCG. This includes any harm to persons and/or other dogs as well as to the physical property of CRCG.

I understand and agree that any problems that develop with my dog will be treated as deemed best by the staff and volunteers of CRCG, in their sole discretion. I assume full financial responsibility for any and all and all expenses involved including injuries to persons and/or dogs, and damages to the facility.

I understand that if an injury caused by my dog or to my dog will only be treated if it is considered to be of a serious nature as determined by CRCG staff in its sole discretion. In the event that treatment is administered, I accept full responsibility for financial obligation of treatment to my dog and any dog injured as a result of my dog’s behavior.

I understand that I am responsible for paying 100% of the cost of a scheduled appointment if I cancel with less than 24 hour notice.

Package refund requests will be calculated by charging the full price for the services used.

I have reviewed and selected the above conditions of the liability agreement. CRCG will be unable to treat my pet if the liability agreement is not completed prior to my first appointment.*

Yes

Photo Release

I grant to CRCG, its representatives and employees the right to take photographs of me and my dog in connection with any CRCG services. I authorize CRCG, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that CRCG may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

Yes
No

CRCG Recreational Pool Policy

CRCG provides fun and safe fitness, conditioning and rehabilitation services. The recreational pool at CRCG is designed for fun swims. The CRCG team cares about the health, safety and welfare of your dog. If your dog has an issue that could contribute to injury while swimming or if your dog is otherwise unable to safely navigate in the recreational pool (this includes incontinence), the CRCG staff will stop the swim and use of the pool will be discontinued until the issue has been resolved. You will be referred to the CRCG rehabilitation services if it is more appropriate for your dog’s condition. You will need a release from a CRCG rehabilitation therapist before returning to the pool if the issue is physical - such as injury, orthopedic or neurological. All rehabilitation clients that are using the recreational pool as part of their rehabilitation plan must follow the treatment plan and requirements for rechecks. The use of the recreational pool will be discontinued if the plan directives are not followed and the recheck requirements are not met.

I agree that there are inherent risks to me associated with use of the CRCG facilities arising out of or associated with use and conditions, such as swimming, wet floors, exercise mats, and other dogs. In consideration for CRCG granting me permission to use these facilities, I agree to release CRCG from liability arising out of or associated with such use, and hereafter waive any and all claims which may arise out of or be associated with such permissive use of the CRCG facilities.*

Owner's Name Date

I certify that I have read and understand this Agreement, and that the information set forth above is true and correct. I agree to accept all the terms, conditions, and statements of this agreement, and any rules or regulations of CRCG.

Name

This field is for validation purposes and should be left unchanged.