You must be 21 years old and have a valid driver's license or picture ID to adopt a pet.
Name of Pet you are interested in adopting
First Name
Last Name
Address
City
State
Zip
Home Phone
Work or Cell Phone
Email Address
I share my home with:
Number of adults
Number of children
Ages of children
Do you or anyone in your household have allergies to small furry critters?Select... Yes No
Do youSelect... Own your own home? Rent
How long have you lived at this address?
If you rent, please complete the following information:
Does your landlord / lease allow pets?Select... Yes No
Landlord's Name
Landlord's Phone
I haveSelect... Never had pets Had pets growing up Always had pets
Current pets in your household:
Who is/has been your veterinarian?
Veterinarian's address / phone
Please tell us about your past pets:
Have you ever surrendered a pet to a shelter?Select... Yes No
If yes, please explain the circumstances:
Why are you interested in adopting a small animal?
Small animals need out of cage time for proper socialization. Do you have a place in your home and a schedule that will allow out-of-cage socialization time with you?Select... Yes No
Please explain
Do you travel?
If yes, who will care for your new pet while you are away?
Are you prepared to take responsibility for your new pet's entire life?Select... Yes No
Please provide at least two personal references. Include their name, telephone # and how this person knows you and your ability to provide a good home for a small animal:
References
How did you hear about the Medfield Animal Shelter?Select... Newspaper Petfinder Animal Control Officer Other
IMPORTANT NOTES
Small animals need to have their cages cleaned on a regular basis. Please make sure you have allocated time in your schedule for proper pet maintenance before adopting.
Small animals like to chew. It is imperative that they are supervised during out-of-cage time so they do not accidentally chew electrical wires or telephone cords or other dangerous objects. Please be sure you have considered the time required to adequately supervise your new pet.
Pets need veterinary care throughout their lives. Before deciding to adopt a pet, please be sure that you've budgeted not only for food, (including plenty of hay and fresh veggies) but also for annual check ups. Please do not adopt a pet if you will not be able to provide him or her with a lifetime of care.
I certify that the information I have given is true, and I understand the Medfield Animal Shelter may contact my veterinarian, personal references and landlord to verify the information on this form. I also agree that if the adoption doesn't work out for any reason, I will return the pet to the Medfield Animal Shelter.