Weight Loss Competition: Participant’s Guide & Waiver
1. This program is completely voluntary.
2. The program begins with an initial weigh-in to get a starting weight. This information is kept
confidential (HSHC staff will keep the journal) if you choose. Must weigh in by April 2nd.
3. Weight loss or maintenance should be the result of healthier eating and more/better exercise
habits. Please no fad diets, diet pills, etc. It is always best to get an ok from your doctor (for
humans) and/or your veterinarian (for animals) before committing to a health plan. If you
choose to join, please participate in a healthy and fair manner.
4. Criteria for winning: At the final weigh-out on June 30th, the HSHC will use the percentage
weight loss calculation to determine the winner.
Waiver:
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I am participating on a voluntary basis in the weight loss challenge.
I understand that weight loss and related recreational/athletic activities may result in injuries to
participants and the HSHC is not to be held responsible.
I believe that I and/or my pet are in good health and can safely participate in this weight loss
competition. If I have any concerns about mine or my pets health I will consult with a physician
and/or a veterinarian.
I understand that the HSHC is not monitoring mine nor my pet’s health or providing any medical
advice or care as part of this weight loss competition.
**I am not aware of any conditions that may affect mine or my pet’s ability to participate; if I do have
any such conditions, I will immediately withdraw from participation and consult my physician or
veterinarian.
By signing below I agree that I release the HSHC from any claims, damages, liability, or demands arising
from mine or my pets participation in this voluntary weight competition, including personal injury,
however caused and whenever realized. I understand that by signing below, I am waiving the right to
bring any potential claim or demand. (Must sign for self if participating, and sign for pet if pet is
participating. If more than one dog please fill out a new form).
Name: __________________________________ Signature: __________________________________
If under 18 – Parent’s Signature needed: ______________________________________________
Pet’s name:_____________________________
Owner signature: _____________________________
Date: _________ Beginning Weight: ___________ Ending Weight: _____________ Total % lost: ______
Weight Loss Competition Recommendations
Purpose:
 Promote healthier eating
 Encourage physical activity
Incentives or Prizes:
 At the end of the competition the HSHC will determine one Dog
winner, and one Human winner based on percentage of weight
lost.
Weight Loss Guidelines:
 Weight Loss should be the result of healthier eating and improved
exercise habits. Participants are on the honor system and should
participate in a healthy and fair manner.
 Prohibited are diet pills, extreme exercise, starvation, and any
other potentially dangerous practices.
Winners determined by percentage using the following calculation.
1. Beginning weight – ending weight = pounds lost
2. (Pounds lost / beginning weight) x 100 = percent of weight lost
This is a more fair comparison than total pounds lost
For most individuals a healthy rate of weight loss is 1% per week. So a
person weighing 280 lbs can safely lose 2-3 lbs per week, while a
person weighing 180 lbs should lose more than 1-2 lbs a week.
Determine your dog’s appropriate weight by veterinarian
recommendation of following the healthy dog weight guide (attached).
This competition runs for 90 days.
The $10 entry fee helps to raise funds for the Humane Society of
Harrison County and to gather the prize packages for the two winners.
All funds received would help to provide veterinarian care (including
vaccinations, spay or neuter, and other medical issues) to the over 800
animals that come through our door each year.
One of the easiest and healthiest ways to exercise is to walk. You can
help us raise even more funds during this challenge by using the Walk a
Dog App. You can download it in the Itunes store (for Apple) or Google
Play (for Android). For each mile walked, we receive a check from
WoofTrax.
There will be a Facebook Group where we can share support and tips
with each other. If interested please provide your Facebook name or
email: __________________________________________________
Weights will remain private and entered into a spreadsheet to be
manned by the staff of the HSHC. At the end of the challenge we will
ask the human winner if they want their actual lbs lost, or just the
percentage. We also recommend taking a before and after picture –
just for yourself. But we would love to use that to announce the
winner.