WELCOME TO THE
NORTHEAST MISSOURI HUMANE SOCIETY
2923 Warren Barrett Drive
P.O. Box 205
Hannibal, MO 63401
(573)-221-9222
Fax (573) 248 - 3074
DATE: ______
In order to be considered for an adoption, you must:
· be 18 years of age
· have the knowledge and consent of all adults living in your household
· have a valid photo ID with current address
· have a landlord’s name and phone number (or lease) if you rent
· and understand the NEMO Humane Society must approve your application
Name ______
Are you 18 years or older? ______
Address ______
City ______County ______State _____ Zip code ______
Home Phone ______Alternate/Work Phone ______
Driver’s License Number ______
DO YOU LIVE IN A . . . House _____ Apartment _____ Mobile home ____
Farm _____ Condo _____ with parents/relatives _____
DO YOU. . . Own ____ Rent _____ (if yes, you MUST provide landlord information).
Landlord’s name ______
Landlord’s phone ______
In your household, there are how many: adults ______children ______
Have they been around animals before? ______
Does everyone in your household know and accept the fact that you are considering adopting a new pet? ______
Which family member will be primarily responsible for?
FEEDING ______TRAINING ______
Please check any spaces indicating why you would like to adopt an animal from us:
COMPANION ______GIFT ______
TO BREED ______WATCHDOG ______MOUSER ______
COMPANION FOR ANOTHER PET ______HUNTING ______
OTHER ______
What type(s) of pets do you own or have owned in the past five years?
TYPE If you no longer have the animal, please explain why.
______
______
______
______
If you currently have or had pet(s) in the past 5 years please explain:
Where do the animals spend most of their time? ______
How are they confined? ______
When, if they are outside, what type of shelter do they have? ______
Who is your veterinarian and where is his office located? ______
When were your pets last vaccinated? ______(We check vet references).
In regards to the pet you are wanting to adopt please explain:
Where will the animal spend most of its time? ______
How will it be confined? ______
When, if it is outside, what type of shelter will it have?______
How much time do you plan to spend with this pet daily? ______
Does anyone in your household have allergies to animals? ______
What will you do with your pet(s) when you leave on an extended vacation? ______
What will happen if your pet grows larger than expected? ______
What behavior(s) will you be unwilling to work with? ______
______
Please list behaviors you feel are unacceptable for your pet. This allows our staff to make recommendations for a pet you may adopt. If you do not understand this question, please discuss it with the staff member assisting you with your adoption.
What would be a convenient time for a representative of the Society to check on the animal’s well-being? ______
If you live within Hannibal city limits, I realize that animals are not allowed to run free, dogs must have a city license renewed each year, and cats and dogs must be vaccinated against rabies yearly. I also understand that the City of Hannibal enforces a 5 pet limit and I cannot adopt an animal that may put my household over this limit. ______(initial).
I realize that my new pet may take anywhere from 2 weeks to 2 months to become adjusted to its new surroundings and may require extra patience and training during this stressful time. ______(initial)
I understand that the NEMO Humane Society is not obligated in any way to give a refund, should an animal be returned. ______(initial)
If you have problems with a pet, you are welcome to call for advice. We recommend also contacting your personal veterinarian for all pet related problems.
The NEMO Humane Society is UNABLE to guarantee the health of any animal adopted, but the shelter staff does its best within its means to screen for and treat common health problems.
STRAYS: I understand that no information is available about the prior history or temperament of this dog/cat/other. (Please initial). ______
By signing below, I certify that the information I have given on this application and in my interview with shelter personnel is true and accurate, and I recognize that any misrepresentation of facts may result in losing the privilege of adopting a pet.
Neither myself, nor any other person living in my household, has ever been convicted, either in the adult or juvenile court system, of any act of animal cruelty or neglect.
I understand that the NEMO Humane Society has the right to deny my request to adopt an animal for any reason, and I authorize investigation of all statements in the application.
I understand that any pet adopted from the NEMO Humane Society will be spayed or neutered before going home. This is not only the philosophy of the NEMO Humane Society but a Missouri State Law. I also understand that my pet should see a veterinarian within 1-2 weeks after adoption.
If I am no longer willing or able to care for this pet for any reason, I AM UNDER OBLIGATION TO RETURN THE ANIMAL TO THE NEMO HUMANE SOCIETY, understanding that I WILL NOT receive a refund of my money. ______(Please initial.)
I WILL NOT GIVE THIS ANIMAL AWAY OR TRY TO SELL IT IN THE FUTURE.
I further understand that this application is the property of the NEMO Humane Society.
SIGNATURE: ______DATE: ______
Northeast Missouri Humane Society
Adoption Contract
2923 Warren Barrett Drive
Hannibal, MO 63401
(573) 221-9222
(Herein NEMO HS)
Today’s date______
Description of animal ______
ID number of animal being adopted______
This pet is available for adoption and is apparently healthy.
Although the animal appears well, an examination by a licensed veterinarian is recommended and should be done as soon as possible.
I realize that the animal I am adopting may have undiagnosed medical problems or may be incubating an infectious condition. I accept all legal and financial responsibility for the continued veterinary care of the animal. I also understand the NEMO HS will not be obligated to provide further financial assistance with diagnosis and veterinary management of this animal.
I understand I am obligated to return this animal to the NEMO HS if I want to or need to relinquish it for any reason. I understand I am obligated to NOT give or sell this animal to any person, organization or facility. I understand the NEMO HS is not obligated to return my adoption fee or reimburse any costs incurred while the animal is in my possession. I understand that a future adoption may be denied depending upon the circumstances of returning this animal and this is at the discretion of the NEMO HS staff.
I understand the NEMO HS is an animal shelter and may speculate but cannot guarantee the physical characteristics of this animal; including but not limited to breed, exact age and size at adulthood.
I have read or have been read this document and fully understand its conditions. I also understand I am signing a legal, binding document.
______
Signature and Date
______
Print Name
______
Witnessed by: (Staff Name)
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