MEDWAY DOG PARK APPLICATION

OWNER NAME: _____________________________________________

ADDRESS: __________________________________________________

TOWN: __________________________ STATE: _____ ZIP: _________

PHONE # (____) __________________

EMAIL (optional): ____________________________________________

DOG’S NAME: __________________________ AGE: ________________

BREED_________________________________

(CIRCLE ONE)             Male-Neutered            Female-Spayed

COLOR(S) ___________________________________________________

Owner Signature: ___________________________________ Date: _______________

(By signing this application, you have read, understand, and agree to abide by all rules and regulations of the

Medway Dog Park.)

Renewable Yearly-beginning January 1st due before May 1st

• SEND THIS FORM, MUST BE FILLED OUT COMPLETELY AND SIGNED TO

BE CONSIDERED

1. •SEND A PHOTO COPY OF YOUR DOG’S CURRENT TOWN LICENSE*****
   

2. •
   

*****DO NOT SEND ORIGINAL PAPERWORK IT WILL NOT BE RETURNED****

• SEND THE COPY OF YOUR DOG’S TOWN LICENSE, SIGNED APPLICATION AND

SELF-ADDRESSED STAMPED ENVELOPE TO:

Millis/ Medway Animal Control

155 Village Street

Medway, MA 02053

*****IF YOU ALREADY HAVE A CURRENT DOG PARK TAG ALL YOU NEED TO SEND FOR

RENEWAL IS A COPY OF YOUR CURENT TOWN LICENSE FOR THE NEW YEAR AND A SELF

ADDRESSED STAMPED ENVELOPE.

APPLICATION CAN BE DENIED FOR ANY OF THE FOLLOWING REASONS

HISTORY OF AGGRESSION, NOT CURRENTLY LICENSED, NOT CURRENTLY VACCINATED.

PERMIT MAY BE REVOKED FOR ANY OF THE FOLLOWING REASONS

FAILURE TO FOLLOW PARK RULES (AFTER BEING WARNED), AGGRESSIVE BEHAVIOR BY

EITHER A DOG OR HIS/HER OWNER(S), INSTIGATING A FIGHT/ CAUSING INJURY TO

PERSON OR OTHER ANIMAL.