License application

 
 

MEDWAY DOG PARK PERMIT APPLICATION

v1.2                                                    06 June 2007


OWNER NAME: _____________________________________________


ADDRESS: __________________________________________________


TOWN: __________________________ STATE: _____ ZIP: _________


PHONE # (____) __________________


EMAIL (optional): ____________________________________________


DOG’S NAME: __________________________ AGE: ________________


BREED_________________________________


(CHECK ONE)            Male-Neutered            Female-Spayed


COLOR(S) ___________________________________________________


Current rabies expiration date: ____________________


Town tag # 20____-_________


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 March 1st,  due before May 1st

  1. •FORM MUST BE FILLED OUT COMPLETELY AND SIGNED TO BE CONSIDERED

  2. •CURRENT RABIES CERTIFICATE MUST ACCOMPANY APPLICATION

    SEND:

  3. •RABIES CERTIFICATE,

  4. •SIGNED APPLICATION

  5. •SELF-ADDRESSED STAMPED ENVELOPE

    TO:                                                                         Millis/ Medway Animal Control

155 Village Street

    Medway, MA 02053


  1. * APPLICATION CAN BE DENIED FOR ANY OF THE FOLLOWING REASONS:  HISTORY  OF AGGRESSION, NOT CURRENTLY LICENSED, NOT CURRENTLY VACCINATED.

  2. * 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.

Permit No. _________________                        Date Issued: ________________

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Please consider donating to the park.  Any little bit helps make the park a more enjoyable place for you and your dogs.


Send check to:


Friends of Medway Dog Park

P.O. Box 724

Medway, MA  02053


(make payable to Friends of Medway Dog park)


Or donate directly to:

Strata Bank

Rt. 109

Medway, MA 


Visitors to the Dog Park are now required to have a Dog Park License for their dog.  They are free but you must apply for one and send in a self-addressed stamped envelope with your application.  You do not have to be a Medway resident to have a dog park license but your dog must be licensed in your town and have a rabies certificate.  You may download the pdf file here or print this page.