You must be 21 years old and have a valid driver's license or picture ID to adopt a pet.
Name of Dog 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 youSelect... Own your own home? Rent
If you rent, you must provide your landlord's contact information so that we may verify you are allowed to have a dog.
Landlord's Name
Landlord's Phone
Landlord's Address
I currently own:
Number of indoor cat(s)
Number of in/out cat(s)
Number of dogs
And these other pets
Are the other pets in your household spayed/neutered?Select... Yes No
Do you or anyone in your house have any known allergies to dogs?
Have you owned a dog before?Select... Yes No
If yes, please provide a brief history of what happened to it. If your last dog died, please state dog's name and date deceased.
Do you have a fenced-in area on your property?Select... Yes No
If you have no fence, how do you plan to have your new dog relieve itself?
Do all adults work full time?Select... Yes No
How many hours each day will your new dog be alone?
Where will your new dog be kept when it is alone?
Where will your new dog sleep at night?
Please provide the contact information of a veterinarian you have used before and plan to use with your new dog. We do check vet references.
Vet Name
Vet Phone
Vet records are under the name of
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 dog:
References
How did you hear about the Medfield Animal Shelter?Select... Newspaper Petfinder Animal Control Officer Other
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.
Pets need veterinary care throughout their lives. Before deciding to adopt a pet, please be sure that you've budgeted not only for food, but also for annual vaccines and check ups, as well as heartworm and flea/tick preventatives. Please do not adopt a pet if you will not be able to provide it with ongoing care.