Client Registration Form

TAD (“The Animal Doctor, Ltd”) Wellness Center

Membership Registration AND Agreement

BY COMPLETING the Membership Identification Section (BELOW) AND BY PURCHASING A TAD WELLNESS CENTER MEMBERSHIP IN ACCORDANCE WITH THE “WELLNESS Options” AND “Shopping Cart” PAGES—WHICH PAGES ARE SUBJECT TO CHANGE AT THE DISCRETION OF THE ANIMAL DOCTOR, LTD—AT www.tadhospitals.com, YOU CERTIFY THAT YOU HAVE READ, UNDERSTOOD, AGREE WITH AND ACCEPT ALL MEMBERSHIP REGISTRATION AGREEMENT TERMS AND CONDITIONS SPECIFIED IN THIS DOCUMENT AND THAT MAY BE CHANGED AT THE SOLE DISCRETION OF THE ANIMAL DOCTOR, LTD.

This TAD WELLNESS CENTER Membership Registration Agreement (hereafter, the “Agreement”) is between THE ANIMAL DOCTOR LTD, a corporation organized and existing under the laws of the state of ILLINOIS, with its principal offices located at 815 FEINBERG COURT, CARY, IL 60013 and herein referred to as “TAD,” and the following pet owner and/or pet custodian as authorized by the pet owner (hereinafter collectively “Client Member”), or Employee of TAD or of a TAD Affiliate (hereinafter “Employee Member”) or an Employee family member. Client Member and Employee Member may hereinafter be referred to as “Member” where such Member is identified as specified in the Member Identification Section of this Agreement as follows (items marked by an asterisk, “*”, are mandatory identifiers that must be provided by and for each Member, including all pets and household members):

Member Identification Section

Complete Every Blank, Using N/A for Not Applicable when Appropriate (BEGIN)

"*" indicates required fields

X/Twitter

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

Member Name(s)*:

Pet Owner #1

Last Name*

First Name*

Middle Initial

Pet Owner #2

Last Name*

First Name*

Middle Initial

Member Household Physical Home or Residence Address*:

Street Address - Street Number and Street Name*

Apartment*

Insert “N/A” if Not Applicable

City or Town*

State*

Zip Code*

Member Email Address*:

Owner #1*

Owner #2*

Member Phone Number(s)*:

Home or Residence*

Mobile or Cellular for Owner #1*

Mobile or Cellular for Owner #2*

Member Type:

Untitled

Client Member

Employee Member

Client Membership is effective as of day of the month of and of the year 20 . The Current, Paid Membership Type *, per www.tadhospitals.com, WELLNESS REGISTER & PURCHASE page, is indicated by checking your intent of selecting ONE of the following four (4) options]:

Day

Annual Membership

Three (3) Month Membership

Month-to-Month Membership

Single Visit: One (1) 20 – 40 Minute Session

Employee Membership, effective as of day of the month of and of the year 20, is ONLY for current employees of THE ANIMAL DOCTOR, LTD and its Affiliates who are in good standing. Client Members have preferred access, relative to Employee Members, to all TAD WELLNESS CENTER Facilities authorized for Membership use:

Day

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Family members of employees may also use the TAD Wellness Center provided each family member is over 18 years of and provided that each family member registers by using this form.

Member Household Pet(s) Names*:

Household Pet #1

Household Pet #2

Household Pet #3 and Other Pets

Member Household Resident(s)*:

All Household Residents Enjoy Membership Privileges at no additional costs, provided that they reside at the Member Household Physical Home or Residence Address, provided each Household Resident completes this agreement and is identified in the following:

Household Resident #1

Last Name

First Name

Household Resident #2

Last Name

First Name

Household Resident #3 or more (Please list all Names, beginning with the 3rd Household Resident)

Last Name

First Name

Last Name

First Name

Last Name

First Name

Total Number of Household Residents of 18 years of Age or Older:

Names of Household Residents Who Are 13 – 17 years of Age (inclusive; written authorization by TAD owner required):

Total Number of Household Residents under the age of 18 years of Age. (Household Residents who are under 13 years of age require written TAD approval to use TAD. Members must be 18 years of age or older:

Electronic Signatures Below Are Required For Membership Approval And Activation By TAD:

For Member:

Last

First

Date

Member ELECTRONIC Signature

I have read, understood and agreed with this entire Agreement