Northeast Arkansas Humane Society | 642106 (Online Adoption)

Online Adoption Application
Name *

First Name Last Name
Adoption Application

Cat Dog Both/Unsure
Prior to the adoption of an animal, we ask that you complete this application. This information will help the NEAHS achieve its goal of finding permanent, responsible, loving homes for the animals in our care and allow us to better assist you in finding a pet well suited to your needs and lifestyle.
I understand that at some point, my pet will need further vaccines and/or emergency care and those costs are solely my responsibility. *

by checking this box you are saying you agree with the above statement
I understand that all adopters must be at least 21 years of age. *

by checking this box you are saying you agree with the above statement
I have a valid government-issued photo ID and am a legal resident of the United States. *

by checking this box you are saying you agree with the above statement
That I must have a plan in place if they become unable to care for this pet *

by checking this box you are saying you agree with the above statement
I understand that I am taking on responsibility for a pet and if I experience a life changing event that prevents me from keeping my pet, I will make every effort to find a loving home for them. In the event a proper home cannot be found, I can always return my pet to NEAHS. *

by checking this box you are saying you agree with the above statement
I affirm I am physically capable and willing to spend the time and money necessary to provide training, medical care and companionship for the life of this animal. *

by checking this box you are saying you agree with the above statement
Email *
example@example.com
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Age *
Employer Name *
Phone Number *

Area Code Phone Number
Housing Type? *

Rent Own Live with Parents
Landlord Name *
Landlord Phone Number

Area Code Phone Number
***if you live with your parents please put their contact info here ****if you own your home please put n/a.
Length of Time at Address *
What is your plan if you become unable to care for this animal? *
Pet needs to be good with:

Children under 8 Children over 8 years Elderly Cats Dogs None of the above
Where will this animal usually spend the day? *
Where will it sleep? *
How do you plan on confining this pet to your property? *
Do you have pets currently? *

Yes No
If so, please list current vet, clinic name and phone number:
Please note if the dog is in someone else's name at the vet's office please note it above
Current pets in the home, please list name, age and breed:
Please review the following adoption policies and information. After reading each item, put a check in the box next to the item. *

Treatment of Adopted Animal –The adopter acknowledges and agrees that the adopted animal will be treated humanely, not used for experimentation, not used for illegal purposes (including dog fighting). The adopter agrees to provide good wholesome food, water, shelter and protection from the weather. Health and Temperament-The NEAHS makes every effort to insure the health of all the pets in our care. However, there is no claim or representation as to the temperament, health, age or mental disposition of any animal put up for adoption. If the adopter chooses to adopt the animal under the circumstances, the adopter acknowledges that they will assume the costs of treating the animal. Adopters assume full responsibility for the animals care two weeks after adoption. Vaccinations - I understand that due to a puppy’s or kitten’s age, the pet may not have been old enough to receive a Rabies vaccine or the last of the other puppy/kitten vaccines. I will need to make and keep an appointment to bring my pet back for the last vaccines. These vaccines are included in the adoption fee. Heartworm Prevention-I understand that I must obtain heartworm prevention for my new dog/ puppy within 30 days of adoption. I also understand that heartworm prevention can only BE OBTAINED THROUGH A VETERINARIAN OR BY A PRESCRIPTION FROM A VETERINARIAN. Return Policy-If the adopted animal becomes ill or develops any undesirable behaviors within 14 days of the adoption date; you may return the pet to the shelter for a full refund. This refund must be made within 14 days. You may always return the pet to us at any point following adoption, if needed. Medical Sterilization- Spay/Neuter surgery of EVERY adopted animal is MANDATORY. Spay/Neuter fees are INCLUDED in the adoption fee and will be done on site prior to taking the pet home. Release & Discharge-The Adopter hereby releases and discharges the NEAHS, its officers, directors, and employees from liability whatsoever from any damage to any person or property caused by adopted animal, and from any causes of action, claims, suits or demands that may arise as a result of injury or damage caused by or to said animal. The Adopter hereby waives any causes of action, claims, suits or demands that Adopter, or his or her heirs, executors or assigns have or may have in the future against the NEAHS, its officers, directors, and employees for any reason whatsoever related to the adoption of the adopted animal, including but not limited to the repossession of the adopted animal in accordance with this contract .Policy and fees are subject to change without notice as amended by NEAHS Board of Directors.
Upon adopting a pet from the NEAHS, I agree to the following: -- I will not keep my pet on a chain or tied up in ANY manner in accordance with city code. -- I give the NEAHS permission to inspect my pet’s new home and repossess the animal if it is found to be receiving inadequate care, or if I do not abide by the terms of this adoption contract. -- If I am unable to care or provide for the pet, I will make every effort to find him a good home and if I cannot find an appropriate home, I will return the pet to NEAHS. I have read, understand, and agree to abide by the above mentioned policies.
Signature *

Clear
Date *

Month Day Year
Should be Empty: