J.M. PET RESORT REGISTRATION FORM

J.M. PET RESORT REGISTRATION FORM Where your pet is a part of our family J.M. PET VET CLINIC / PLAYtrain DAYCARE / BOARDING / TRAINING / GROOMING Date Name of owner: Co-owner: E-mail (1): E-mail (2): Address: City/State: Zip: Home phone: Work phone: ext. Cell phone (1): Cell phone (2): May we contact you via text message? Yes / No If so, pls list cell phone provider: Emergency contact: Phone: Emergency contact: Phone: Emergency contact: Phone: Pet s name: Breed: Colors/distinct markings: Sex: M F Spayed/Neutered: (Pls circle) Yes / No At what age was pet spayed/neutered? Veterinarian name/clinic: Phone: Pet s DOB: Age when obtained: From where: Pet s weight: What kind of food do you feed your pet? How much do you feed? Frequency: Health4PETS RELATED QUESTIONS Does pet have any allergies? Yes / No Pls identify: Any illness, skin disorder, cuts or lacerations in the last 6 mos.? Was it treated by a vet? Yes / No Does pet have any physical disabilities that may affect training? Yes / No Does pet have any chronic medical conditions or allergies? Is pet currently on any medications or supplements? Yes / No If yes, pls explain: Is pet crate trained? Yes / No Is pet sensitive/fearful of anything? Yes / No If yes, pls explain: Does your dog mount other animals or objects? Yes / No If yes, who or what does he/she mount? Does your dog ever bark at you? Yes / No If yes, when does your dog bark at you? Please describe: Does your dog bark at other times? Yes / No If yes, please describe: Rev. 4.23.18 1014 Pearl Street, Brockton MA 02301 / 508.588.5661 / jmpetresort.com Page 1 of 6

J.M. PET RESORT REGISTRATION FORM J.M. PET VET CLINIC / PLAYtrain DAYCARE / BOARDING / TRAINING / GROOMING Has your dog received any formal obedience training? Yes / No If yes, at what age? Method of training: Food Head collar Leash corrections Shock collar Clicker Has your dog ever used a bark collar? Yes / No If yes, for what reason? Has your dog ever bitten a person? Yes / No If yes, was it reported? Was your dog quarantined? Yes / No Did the bite require medical treatment? Yes / No If yes, pls describe: Has your dog ever bitten another animal? Yes / No If yes, what kind? Did the bite require medical treatment? Yes / No If yes, pls describe: Please place a check mark in each behavior demonstrated. Situations No reaction Lift lip Growl Bark Lunge/ Snap Bite Not tried Dog eating out of its bowl... walk by, reach for, take away Dog is eating a real bone walk by, reach for, take away Dog is eating rawhide/pig s ear walk by, reach for, take away Dog has toy walk by, reach for, take away Disturb dog while in crate Put on leash, collar, or harness Brush / groom dog Trim dog s nails What brought you in to J.M. Pet Resort today? What brought you in to J.M. Pet Vet today? How did you learn about J.M. Pet Resort? How did you learn about J.M. Pet Vet? What are you registering for today? Obedience Training Private Lessons PLAYtrain Daycare Boarding Grooming J.M. Pet Vet Clinic Are you interested in other services that J.M. Pet Resort offers? q J.M. Pet Vet Clinic q PLAYtrain Daycare q Motivational Training q Boarding q Private Lessons q Grooming q Pet Taxi Register an additional pet on page 3, otherwise move on to page 4 1014 Pearl Street, Brockton MA 02301 / 508.588.5661 / jmpetresort.com Page 2 of 6

J.M. PET RESORT REGISTRATION FORM **FOR ADDITIONAL PET IN SAME HOUSEHOLD** Pet's name (2) : Breed: Colors/distinct markings: Sex: M F Pet s DOB: Age when obtained: From where: Spayed/Neutered: (Pls circle) Yes / No At what age was pet spayed/neutered? Pet s weight: What kind of food do you feed your pet? How much do you feed? Frequency: Does pet have any allergies? Yes / No Pls identify: Any illness, skin disorder, cuts or lacerations in the last 6 mos.? Was it treated by a vet? Yes / No Does pet have any physical disabilities that may affect training? Yes / No Does pet have any chronic medical conditions or allergies? Is pet currently on any medications or supplements? Yes / No If yes, pls explain: Is pet crate trained? Yes / No Is pet sensitive/fearful of anything? Yes / No If yes, pls explain: Does your dog mount people? Yes / No If yes, whom does he/she mount? Does your dog mount other animals or objects? Yes / No If yes, who or what does he/she mount? Does your dog ever bark at you? Yes / No If yes, when does your dog bark at you? Please describe: Does your dog bark at other times? Yes / No If yes, please describe: Has your dog received any formal obedience training? Yes / No If yes, at what age? Method of training: Food Head collar Leash corrections Shock collar Clicker Has your dog ever used a bark collar? Yes / No If yes, for what reason? Has your dog ever bitten a person? Yes / No If yes, was it reported? Was dog quarantined? Yes / No Did bite require medical treatment? Yes / No If yes, pls describe: Has your dog ever bitten another animal? Yes / No If yes, what kind? Did the bite require medical treatment? Yes / No If yes, pls describe: Please place a check mark in each behavior demonstrated. Situations No reaction Lift lip Growl Bark Lunge/ Snap Bite Not tried Dog eating out of its bowl... walk by, reach for, take away Dog is eating a real bone walk by, reach for, take away Dog is eating rawhide/pig s ear walk by, reach for, take away Dog has toy walk by, reach for, take away Disturb dog while in crate Put on leash, collar, or harness Brush / groom dog Trim dog s nails Page 3 of 6

J.M. Pet Resort and J.M. Pet Vet General Release of Liability and Surgical Release I hereby waive and release J.M. Pet Resort and J.M. Pet Vet, hereafter referred to as J.M., its employees, owners and agents from any and all liability of any nature, for injury or damage which I, any member of my family, or my dog may suffer, including specifically, but not without limitation, to any injury or damage resulting from the action of any dog. I expressly assume the risk of any such damage or injury sustained while on the premises of J.M. and as a result of my dealings with J.M. wheresoever it may occur. _ I understand that obedience classes at J.M. are for the purpose of teaching me to better train my own dog basic on and off-leash commands. I understand that attendance at dog obedience training class is not without risk to myself, members of my family or guests whom may attend, or to my dog. I acknowledge that some of the dogs to which I (we) will be exposed may be difficult to control and may cause injury even when handled with the greatest amount of care. I understand that no canine is 100% predictable or perfect. I understand that obedience training techniques are only effective when reinforced on a consistent basis and thus, I realize that even with training, unpredictable conduct may occur without warning. I understand that any harm my dog may inflict on any person or animal during and after a training session, or at any time in the canine's life is not the responsibility of J.M. I hereby indemnify and hold harmless J.M., its employees, owners and agents from any and all injury or damages caused by my dog to myself, any member of my family or any other person. _ In consideration of, and as inducement to, the acceptance of my pet to obedience training class, boarding, or doggie daycare at J.M., I hereby release and hold harmless, J.M., its employees, owners and agents from any and all claims for damage or injury to myself or any member of my family or any other person accompanying me to any training session or function of J.M. while on the grounds or the surrounding area thereto, wheresoever it may occur. _ I understand that when I sign up and pay for an obedience class that it takes an available limited space for a prospective guardian/dog team and that because of this there are NO REFUNDS on obedience classes. _ I understand that in the case of illness or injury to my dog while in the care of J.M. with or without my presence, I hereby permit J.M. and its agents to seek treatment. I understand that I am solely responsible for payment for any veterinary care provided to my dog. I also understand that J.M. primarily uses J.M. Pet Vet Clinic for any care rendered to the animals in our care, or any other 24 hour pet care facility for afterhours care. I hereby give consent to charge my credit card on account to pay for any such care. I understand and agree that I am solely responsible for the payment of all medical bills for my pet, including those incurred at J.M. Pet Vet and/or any designated 24 hour pet care facility for afterhours care. I hereby release and indemnify J.M., its owner and employees, of and from any and all liability for claims, damages and debt, arising out of, or related to such medical care, including but not limited to care provided by J.M. Pet Vet, and transportation to/from any other pet care facility or the owner s specified veterinarian clinic. _ I understand that if I leave my dog beyond the scheduled stay, I am responsible for full payment of any and all additional boarding and care. I understand that upon exceeding the scheduled stay by 10 days or more, I have abandoned my dog, and J.M. has full authority to care for and place the dog as J.M. sees fit. This includes but is not limited to: adopting the dog out, surrendering the dog to an animal shelter for adoption or attention as that shelter deems necessary _ Page 4 of 6

J.M. Pet Resort and J.M. Pet Vet General Release of Liability and Surgical Release Boarding Reservations: I understand that J.M. requires a 48 hour notice for a cancellation for any peak rate booking and a 24 hour notice for non-peak rate booking. A cancellation made without sufficient notice will incur a $25 non-cancellation fee. Credit Card: I understand that it is required to have a current credit card on file with J.M. to be used in the following instances: if there are any veterinary bills during my pet's stay, if there are any unpaid balances and/or late fees on those balances, if I abandon my pet, and if non-cancellation charges apply. Effective every Monday, all charges accrued for Daycare Service, Pet Sitting and Retail Products for the week prior, will be charged to the credit card we have on file for you. All expenses related to J.M. Pet Vet, Grooming, Boarding, and Training (or at the time of booking for Training) are due and payable upon receipt of service. If J.M. is unable to process your credit card on Monday for reasons beyond our control, a $15 surcharge will be implemented. I understand that there is a 10% late fee assessed on outstanding balances every month over 30 days. Collars and Identification: All dogs boarding or attending daycare must have a properly fitted flat collar with identification. Collars and tags are the owner's responsibility. Personal Belongings: Toys, blankets, beds, etc. are welcomed. However, there is NO GUARANTEE that we will be able to return items if you so choose to bring your own. Owners should be aware that we provide blankets or bedding. Outdoor Play: While your pet is staying with J.M., he or she will be playing in a natural, outdoor play area and your dog is likely to get dirty. We highly recommend grooming services, such as a brush-out or bath before they go home. Meals: J.M. strongly recommends that all owners bring their beloved pet's regular diet as to not upset their normal eating habits and digestive system. We will serve a bland diet to anyone who does not prepare meals at a $1.50 per meal charge. PLEASE DO NOT BRING BOWLS. We have special bowls that can be sterilized. Medications, Insulin Shots, Medical Treatments: There is a fully qualified technician on every shift to accommodate any of these needs. Administering medications range from $2.00 to $5.00 per treatment. All prices are subject to change based on difficulty measures. Vaccinations: No exceptions! All puppies 5 months and younger must have proof of at least 2 DHPP vaccines, canine cough vaccine, the 2-part canine bivalent influenza vaccine, all at least 10 days prior to admission. All dogs 5 months and older must have proof of a current DHPP, canine bivalent influenza vaccine, Rabies, and current on the semi-annual (every 6 months) canine cough vaccine. We also strongly recommend that your pet receive the Leptospirosis vaccine. Fleas, Ticks and Parasites: All dogs and cats that play and board at J.M. Pet Resort must be flea, tick and parasite free. Thus, any pet that is seen with any of the fore-mentioned problems will be treated at the owner's expense. I understand that I am responsible to update any and all personal information and information regarding my pet as it changes. Page 5 of 6

J.M. Pet Resort and J.M. Pet Vet General Release of Liability and Surgical Release Injuries: The staff at J.M. makes every effort to be certain that the dogs here are safe in playgroup. We require temperament tests and we match personalities, level of energy and ages in our groups. The PLAYtrain attendants are skilled at watching body language and interrupting play times before any problems ever occur. We employ time outs when needed and will sometimes remove dogs from playgroups that are having a bad day all together. A doggie daycare is not unlike a child's daycare in that accidents do sometimes happen (fall off of the slide, another child pokes another child in the eye, etc.). Even with the utmost care and watchful eyes, dogs can sometimes nip or bite or scratch as they play with their mouths and paws. So what happens when an injury occurs? Each owner is responsible for his or her own dog. Of course, we do EVERYTHING we can to avoid problems but they are all here to have fun, wrestle and run around and sometimes play gets out of hand. We feel that the benefits of exercising and socializing your dog(s) outweigh the drawbacks of the occasional scratch or bite that may occur. This is much like the occasional knee skinning from rollerblading witha child or raspberry from sliding into home plate. It's all in good FUN. J.M. Pet Vet Release: I, the undersigned hereby certify I am the owner or appointed agent and I hereby authorize the staff of J.M. Pet Vet to examine, prescribe for, treat, and/or perform procedures of the above-described animal. I have been informed of the risks and the benefits associated with performing medical procedures(s) on my pet. I acknowledge and understand that the above stated procedure(s) bear(s) certain known and unknown risks or unanticipated risks, which could result in injury to my pet, including, the possibility of its death. I also understand and realize that additional risks of the procedures(s) may include adverse reactions to my pet, such as, but not limited to, allergic reactions from medications and/or complications experienced during (or after) surgery. I understand sedation and anesthesia involves risk to my pet and that staff members will use all reasonable precautions against the injury, escape or death of my pet. I realize that there are risks involved with any anesthetic or surgical procedure and that no guarantee or warranty can be made regarding the results. I hereby release and hold harmless J.M. Pet Resort and J.M. Pet Vet from liability for damages of any nature that arise from such treatment and procedures. If this animal should injure itself in an escape attempt, soil itself, become ill, become exposed to infectious disease or die while in the clinic, I hereby release, indemnify and hold harmless J.M. Pet Resort and J.M. Pet Vet of any responsibility and liability from any such injury and damages. I further understand that during the course of the operations or procedures, unforeseen conditions may arise that may necessitate the performance of additional procedures. I assume financial responsibility for all charges incurred for such procedures and for the care of this animal. I also understand that these charges will be paid at the time of release of my pet and that a deposit may be required for treatment. Initial I understand that J.M. Pet Resort and J.M. Pet Vet have the irrevocable and unrestricted right to utilize or publish photographic or video images of my pet for marketing and promotional purposes, without expectation or compensation. All such images remain the sole property of J.M. Pet Resort and J.M. Pet Vet. I understand the by signing below, I agree to be bound by the terms of this agreement each time I visit J.M. Pet Resort and J.M. Pet Vet. I agree to release and hold harmless J.M. Pet Resort and J.M. Pet Vet, its employees, owners, customers and animal owners of any and all liability of injuries to myself, any member of my family, and my pet. I also understand that any and all veterinary care that may arise from a dog-dog interaction, any illness or any other injury that may occur is solely my responsibility. If this form is submitted online, I agree to sign a printed version of the submitted form upon my first visit to J.M. With or without my signature, I agree that submission of this online form is equivalent to me signing the form in person in every way. We agree to provide your beloved companion with the professional care and love that they deserve. We look forward to your patronage. Date: Print name: Owner signature: Page 6 of 6