Pigture Perfect Dog Adoption Application

Northeast Missouri Humane Society

Dog Adoption Application
Founded in 1966 on compassion as a Non-Profit 501 (c) (3), NEMO Humane Society currently cares for the lost, stray, injured, neglected and unwanted animals of five counties which include Marion, Ralls, Monroe, Shelby and Lewis. The Northeast Missouri Humane Society is committed to investing their expertise and resources to further achieve their cause. Their mission is to prevent neglect, abuse, cruelty, and overpopulation of domestic animals, to provide a network service to the lost or homeless, and to educate the public on problems that matter. They exist to make a difference. Each year they care for nearly 2000 homeless pets from the Northeast Missouri area. NEMOHS continues to have a contract with the City of Hannibal to provide a home for strays picked up by the city's Animal Control. The staff and board members take their responsibility very seriously and appreciate the support of the community. Just imagine what we can achieve together! The possibilities are endless.
This questionnaire is designed to help NEMOHS and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. NEMOHS reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!

In order to be considered for adoption, you must:
- Be 21 years of age
- All adults in the household, must consent to the adoption
- If you rent, you must have the landlord's name and phone number
Name of the dog you are interested in:*
Are you aware that there will be an adoption fee, of $150, associated with the dog you are applying to adopt? Are you prepared to make the adoption fee payment, in full, prior to finalizing the adoption and taking the dog home?*

YesNo

Applicant Information
Name*

First NameLast Name
Your age:*
Birthdate:*

MonthDayYear
Date
Street Address:*
City, State, Zip*
Applicant's Phone:*

Area CodePhone Number
Applicant's E-mail:*
Applicant's Driver's License or SSN#:*

I understand that I am signing a legal, binding document and I have read, or have had this document read to me and fully understand its conditions.
Date*

MonthDayYear
Date
Signature

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Northeast Missouri Humane Society

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information