Pet Owner Name:    ___________________________________________

Address:                  ___________________________________________

Telephone Number: ___________________________________________

Check One:     Dog ________      Cat ________

Description of Pet:

Breed: _______________________    Color:    _________________________

Approx. Weight (at full size): _______________     Name:    _________________________

Chelmsford License # (dogs only)      __________________________________________

Note: All dogs must have a current license issued by the Town of Chelmsford.

Below is Rule #7 of the Scotty Hollow Rules and Regulations of which all pet owners must abide:

"7. HOUSEHOLD PETS. No dogs, cats or other animals may be kept in any Unit without the prior written consent of the Trustees. All pets must be curbed in all Common Areas and Facilities, and no pet shall be left unattended in the Common Areas and Facilities. If any pet creates offensive noise, is allowed outdoors except on a leash, or in any way creates a disturbance, the Trustees may revoke their consent and require that the pet be removed from the Condominium, and the Owner of the pet shall immediately comply with such request. Each owner shall hold the Trustees and each of the other Unit Owners and their respective agents and employees harmless against loss, liability, damage or expense resulting from any actions of his or her pet(s) within the Condominium."

Pet Owner must sign below in acknowledgment of the pet guidelines noted above and their pledge to abide by same:

Pet Owner Signature:  _____________________________________________    Date:  __________