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1 333 North Bedford Road Mt. Kisco, NY Phone: Fax: Website: ckatthepark.com APPLICATION Owner Information Name Address Date Home phone Work phone Cell phone Services Interested In Daycare Boarding Grooming Training Puppy Playgroup How did you hear about us? Emergency Contact Information Spouse/Significant Other Name Phone Someone Outside Immediate Family Name Phone Relationship Veterinarian Information Hospital Doctor City/State: Phone

2 Page 2 Dog Information General Name Primary Breed Sex Male Female Birth Date Color Neutered/Spayed Yes No Weight Where did you get your dog? How long have you had your dog? Other Household Pets Species Sex Neutered Age Medical History Please attach a copy of your most recent veterinarian vaccine records showing proof of Rabies vaccine, DHLPP (distemper) vaccine, Bordetella (Canine cough) vaccine and a Fecal exam. Type/frequency of flea/tick preventative Please list below any current or past medical problems/treatments or allergies

3 Page 3 Behavior Has your dog ever... Been to obedience class? Been socialized to other dogs? Jumped a fence? Had to share food/water/toys with other dogs? Growled at a person? Growled at another dog? Bitten a person? Bitten another dog? Other Information What do you hope to achieve for you and your dog by utilizing our services? Is there anything else you would like to share with us about your dog? (Version 1.0)

4 333 North Bedford Road Mt. Kisco, NY Phone: Fax: Website: ckatthepark.com CLIENT AGREEMENT For myself, my heirs and any assigns, I hereby release Canine Kindergarten at The Park (assumed name for Lake Dogs, Inc.), its agents, officers, subcontractors, employees, animal parents, customers and potential customers of Canine Kindergarten at The Park from any and all liabilities for injuries to myself, my dog, or any other property of mine which arise in any way out of services and/or products provided by or as a consequence of my association with Canine Kindergarten at The Park. I acknowledge and understand that every dog reacts differently and that animals by nature are unpredictable. Canine Kindergarten at The Park takes all reasonable steps to provide a safe and stimulating environment for dogs in its care. I acknowledge and understand that dogs may, with or without warning, bite or cause injury or illness to humans, other dogs or even themselves. I voluntarily assume the risks associated with my dog and/or myself participating in daycare, as well as the risks related to our presence on Canine Kindergarten at The Park property, including but not limited to dog fights, dog bites to humans and /or other dogs and the transmission of illness (e.g. kennel cough), disease and/or parasites. If my dog becomes ill or injured while in the care of Canine Kindergarten at The Park, or if the state of the animal s health otherwise requires professional attention, Canine Kindergarten at The Park, in its sole discretion, may engage emergency services of a veterinarian or administer medicine or give other requisite attention to the dog, and the expenses thereof shall be paid by me, the client. In consideration of the services being performed by Canine Kindergarten at The Park, I further agree to release Canine Kindergarten at The Park from liability for injury, illness, or death of said dog. In case of the need for transportation services (e.g. emergency vet visit, pick-up, delivery), I recognize the risks of injury that accompany said transport and acknowledge that I grant this RELEASE as it is being relied upon by Canine Kindergarten at The Park to permit transport of my dog to and from Canine Kindergarten at The Park or any other necessary location. Furthermore, I accept and understand any and all conditions, rules and regulations promulgated by Canine Kindergarten at The Park associated with the activities, use of the facilities and transport, and hereby agree to comply with them. I also state that none of these conditions, rules and regulations is unconscionable. Read and Initial Each Item Below Dogs not familiar with Canine Kindergarten at The Park may experience anxiety when apart from their human companions.

5 Page 2 Dogs not regularly exposed to the level of activity at Canine Kindergarten at The Park may feel the discomfort of sore muscles, sore joints and fatigue. Dogs not regularly exposed to outside activity or play on hard surfaces may experience sore paws, blisters, bruises or abrasions on the feet (raw paw). Dogs at play during daycare do get dirty. Dogs with longer hair can get matted from the level of activity at daycare. Baths and brush outs can be requested and scheduled. Excessively long toenails may cause injury. You will be notified if your dog s nails are too long. If, at your next visit, the nails have not been trimmed, Canine Kindergarten at The Park will have them trimmed at client s expense. Dogs not regularly socialized do not necessarily know how to behave politely with other dogs. These dogs are at higher risk of incidents including, but not limited to, bites, fights, fear aggression, object guarding, behavior problems and/or acting out. I understand the extra risks my puppy has of contracting disease or illness by entering the daycare program without being fully vaccinated. Water is available at all times; however, your dog may still be thirsty after daycare. Be aware of their water intake as excessive amounts may cause an upset stomach or other problems. Dramatic changes in food and/or food quality may cause upset stomachs, diarrhea, and/or colitis. Any behavior deemed dangerous or inappropriate by Canine Kindergarten at The Park may result in dismissal from the program. I understand and agree that my dog is in good health and has not been ill with any communicable disease within the last 30 days. I agree that Canine Kindergarten at The Park has permission to obtain my dog s medical records from my veterinarian. I understand Canine Kindergarten at The Park staff give all dogs involved in any type of incident a cursory examination, however, Canine Kindergarten at The Park is not liable for the location, treatment or diagnosis of any injuries incurred on our premises. It is recommended you check your dog further or seek treatment for your pet by a licensed veterinarian at your discretion and cost. I understand that Canine Kindergarten at The Park has the right to deny services to me and my dog, at any time, for any reason. I agree that if for any reason my dog must be removed from the Canine Kindergarten at The Park premises, I, or someone I designate (i.e. emergency contact), will come and pick up my dog within a reasonable timeframe. I understand that if my dog is left at Canine Kindergarten at The Park for a period of three days without their prior knowledge or contact from me, the dog will be considered abandoned and necessary steps will be taken to turn the animal over to the proper authorities. I agree to pay for all services due at the time they are rendered. I understand any unpaid fees by me will be sent to collections and I will be responsible for all collections and legal fees incurred by such actions taken. I agree that Canine Kindergarten at The Park may use pictures of my dog for publicity or promotional purposes without any liability or obligation to me. I have read and understand the Canine Kindergarten at The Park Rules and Regulations.

6 Page 3 I certify that I have read the entire Agreement and understand, and agree, and intend on my own behalf, and on behalf of my agents, representatives, relatives, successors, and assigns, to be bound by all the terms and conditions contained in this Agreement and release Canine Kindergarten at The Park of all liability, no matter the cause. Client Name Client Signature Date (Version 1.0)

7 333 North Bedford Road Mt. Kisco, NY Phone: Fax: Website: ckatthepark.com RULES AND REGULATIONS To ensure the safety and health of all dogs and staff at Canine Kindergarten at The Park, we require all clients to comply with the following Rules and Regulations: SEX: All dogs must be spayed or neutered (unless they are under seven (7) months of age). VACCINATIONS AND PREVENTATIVE: All dogs must be up to date on vaccinations. All clients must submit written verification from their veterinarian that their dogs have current Distemper, Hepatitis, Leptospirosis, Parainfluenza and Parvo Virus (DHLPP), Rabies, and Bordetella (Kennel Cough) vaccinations. All dogs should also be receiving flea preventative and heartworm prevention on a monthly basis. Results of a current fecal exam are necessary to verify that none of our canine clients have intestinal parasites that may spread to other dogs. You will receive reminders when vaccinations are due. However, it is your responsibility to provide on-going verification of current vaccinations. HEALTH: All dogs must be in good health to attend daycare. All clients will need to certify that their dogs are in good health and have been free from any condition that could potentially jeopardize other canine clients. Dogs that have been ill with a communicable condition in the last 30 days will require written veterinary certification of health to be admitted or readmitted. If, at any time during our care, it becomes evident that your dog is ill, you will be notified and expected to pick-up the dog immediately. If, at any time during our care, it becomes evident a dog has fleas or ticks, treatment will be applied and charged to the client at the minimum rate of $ All dogs will be examined for signs of fleas and ticks at check in and will not be admitted to daycare if fleas or signs of fleas or ticks are discovered. The spot check is not a foolproof process; therefore, Canine Kindergarten at The Park requires a flea and tick preventative for incoming dogs, excluding flea/tick collars. In addition, to minimize the possibility of communicating illness or disease, we do not accept dogs that have been at another daycare or boarding facility within a one week period (except for certain approved daycares; ask Canine Kindergarten at The Park for more details). LEASHES AND COLLARS: Quick release collars with nametags are required. All dogs must enter and exit the facility on leash. Retractable leashes are not allowed. FOOD: All food brought to Canine Kindergarten at The Park must be stored in an airtight container and labeled with the dog s and owner s names. BEHAVIOR: All dogs must pass the Canine Kindergarten at The Park Behavior Evaluation for enrollment in our program. All dogs must be non-aggressive and not food or toy protective. Clients will need to certify that their dogs have not harmed or shown any aggressive or threatening behavior towards any

8 Page 2 person or any other dogs. Please remember that your dog will be spending time with other dogs and that their safety and health is our main priority. Keep in mind, although it is supervised play, your dog still might acquire an occasional nip or scratch. AGE: All dogs must be at least 16 weeks of age to attend daycare. Puppies may participate in daycare before they are altered, as long as it will be completed by the time they are seven (7) months old. REGISTRATION: All dogs must have a complete, up-to-date and approved Registration Packet on file. If your dog has not attended Canine Kindergarten at The Park for three (3) months or more, we may require a daycare visit prior to any boarding stays. FEES: All fees are payable at the end of each day. Cash, Checks, MasterCard, VISA and Discover are accepted. A $30.00 fee will be applied for any returned check. Discounted packages are provided only if they are paid in advance. Discounted packages must be used by their expiration date. Pre paid packages are non-refundable. HOURS OF OPERATION: Daycare is available Monday through Sunday from 6:45 a.m. to 7:00 p.m. Daycare ends promptly at 7:00 p.m. A late charge of $10.00 will be applied after 7:00 p.m. No pick-ups allowed after 7:30 p.m. RESERVATIONS AND CANCELLATIONS: Reservations are required. A daycare reservation must be cancelled at least twenty four (24) hours in advance or you will be charged for the day. Boarding reservations for non-holiday periods must be cancelled at least forty eight (48) hours in advance or you will be charged 1 day and 1 night. Boarding reservations for holiday periods must be cancelled at least 1 week in advance or you will be charged 2 days and 2 nights. I certify that I have read the Rules and Regulations and understand, and agree, and intend on my own behalf, and on behalf of my agents, representatives, relatives, successors, and assigns, to be bound by all the terms and conditions contained in the Rules and Regulations. Rules and Regulations are subject to change without notice. Client Name Client Signature Date (Version 1.0)

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