Dog Adoption Application | Medfield Animal Shelter

Name of Dog you are interested in adopting:*

First Name*

Last Name*

Address*

City*

State*

Zip*

Email*

Enter Email Confirm Email

Phone

I share my home with:

Number of adults

Number of children

Ages of children

Do you

If you rent, you must provide your landlord's contact information so that we may verify you are allowed to have a dog.

If you rent, please provide your 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?

Do you or anyone in your house have any known allergies to dogs?

Have you owned a dog before?

Do you have a fenced-in area on your property?

If you have no fence, how do you plan to have your new dog relieve itself?

Do all adults work full time?

How many hours each day will your dog be alone?

Where will your dog be kept when it is alone?

Where will your dog sleep at night?

Is there any additional information you wish to share about your home or the type of dog you are looking for?

Veterinarian's name (if you have had pets)

Veterinarian's Phone #

Name of the pet vet records are under: (We do check vet references, so please be sure to call your vet to give them permission to speak to us)

How did you hear about the Medfield Animal Shelter?

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.

Dog Application