CARRMISSOURI CAMPUS - ADOPTION APPLICATION

PO BOX 101, HOLDEN, MO 64040-0101 

EMAIL: CARRMISSOURICAMPUS@GMAIL.COM


NAME OF ANIMAL INTERESTED IN ADOPTING:

FIRST NAME OF ADOPTER:

LAST NAME OF ADOPTER:

ADOPTERS DATE OF BIRTH: 

FIRST NAME OF ADOPTERS SPOUSE/ROOMMATE:

LAST NAME OF ADOPTERS SPOUSE/ROOMMATE:

STREET ADDRESS OF ADOPTER:

CITY OF ADOPTER:

STATE OF ADOPTER:

ZIP CODE OF ADOPTER:

*IF YOU ARE A RENTER, PLEASE PROVIDE NAME OF LANDLORD AND PHONE NUMBER

HOME PHONE NUMBER OF ADOPTER:

CELL PHONE NUMBER OF ADOPTER:

WORK PHONE NUMBER OF ADOPTER:

NAME OF EMPLOYER:

SUPERVISOR NAME:

SUPERVISOR PHONE NUMBER:

TIME ON JOB: (DAYS/WEEKS/MONTHS/YEARS):

NAME OF VETERINARIAN OFFICE:

PHONE NUMBER OF VETERINARIAN OFFICE:

TIME USED THIS VETERINARIAN OFFICE: (DAYS/WEEKS/MONTHS/YEARS)

CURRENT PETS (LIST EACH: NAME, BREED, AGE, SEX, SPAYED/NEUTERED?, CURRENT ON VACCINATIONS?)

HAVE YOU EVER SURRENDERED A PET? IF YES, PLEASE EXPLAIN.

DO YOU HAVE CHILDREN (UNDER 18 YEARS)? IF YES, PLEASE PROVIDE NAME AND AGES.

PLEASE LIST NAME/AGE OF ALL ADULTS 18 AND UP THAT RESIDE IN YOUR HOME:

PLEASE PROVIDE TWO REFERENCES (NOT FAMILY MEMBERS)

FULL NAME OF REFERENCE ONE:

PHONE NUMBER OF REFERENCE ONE:

FULL NAME OF REFERENCE TWO:

PHONE NUMBER OF REFERENCE TWO:

IF WISHING TO ADOPT A PUPPY/DOG, PLEASE COMPLETE THESE QUESTIONS:

IF THE DOG IS NOT HOUSEBROKEN, WHAT WILL YOU DO?

IF THE DOG CHEWS ON FURNITURE, WHAT WILL YOU DO?

IF THE DOG IS NOT LEASH TRAINED, WHAT WILL YOU DO?

WHERE WILL THE DOG SPEND MAJORITY OF EACH DAY?

HOW DO YOU PLAN TO CONTAIN DOG ON YOUR PROPERTY?

IF WISHING TO ADOPT A KITTEN/CAT, PLEASE COMPLETE THESE QUESTIONS:

IF THE CAT IS NOT LITTER BOX TRAINED WHAT WILL YOU DO?

IF THE CAT STARTS SCRATCHING FURNITURE, WHAT WILL YOU DO?

WOULD YOU HAVE THE PROCEDURE ONYCHECTOMY (DECLAWING) PERFORMED ON THIS CAT?

IF SOMEONE IN YOUR HOME BECOMES ALLERGIC TO CAT WHAT WILL YOU DO?

DO YOU PLAN TO LET YOUR CAT OUTSIDE? iF YES EXPLAIN HOW YOU PLAN TO CONTAIN ON YOUR PROPERTY.


*EVERYONE MUST ANSWER THESE QUESTIONS.

DO YOU UNDERSTAND YOUR LOCAL AND STATE ORDINANCES FOR PROPER LICENSING OF YOUR PETS?

DO YOU PLAN TO FOLLOW THESE ORDINANCES?

DO YOU UNDERSTAND YOU ARE RESPONSIBLE FOR YOUR PET(S) BEFORE, DURING AND AFTER A DISASTER?

HOW MUCH DO YOU PLAN TO SPEND ON MEDICAL CARE EACH MONTH FOR THIS PET?

HOW MUCH DO YOU PLAN TO SPEND ON FOOD AND SUPPLIES EACH MONTH FOR THIS PET?

ARE YOU WILLING TO WORK THROUGH THE TRANSITION PERIOD WITH THIS PET (YOU MUST BE WILLING TO ALLOW UP TO 30 DAYS) AND IF NECESSARY A PROFESSIONAL TRAINER AT YOUR OWN EXPENSE?

DO YOU AGREE THAT IF THIS IS NOT THE RIGHT PET FOR YOU THEN TO FOSTER THE PET FOR US UNTIL WE CAN SETUP PROPER TRANSPORT FOR THE PET TO BE RETURNED TO US? THIS COULD TAKE UP TO 30 DAYS.

DO YOU AGREE TO CONTACT US IMMEDIATELY, IF THIS PET IS NOT RIGHT FOR YOU?

ANY ADDITIONAL INFORMATION YOU WISH TO LET US KNOW ABOUT?


ACKNOWLEDGEMENT/UNDERSTANDING AND AGREEMENT

I/WE HEREBY ACKNOWLEDGE THAT THIS DOG/CAT IS RESCUED AND MOST LIKELY A STRAY AND THEREFORE CARRMISSOURI HAS NO KNOWLEDGE ABOUT THE ANIMALS ABILITY TO GET ALONG WITH PEOPLE, CHILDREN, OTHER DOGS, CATS OR OTHER ANIMALS BEYOND OUR LIMITED EXPERIENCE WITH THE ANIMAL AT OUR FACILITY. THIS ANIMAL COMES WITH NO MEDICAL HISTORY OTHER THAN WHAT WAS OBSERVED, DETECTED OR PROVIDED AT OUR FACILITY. THE AGE OF THIS PET IS DETERMINED BY A VETERINARIAN TO THE BEST OF HIS/HER ABILITY. THIS PET MAY HAVE BEEN EXPOSED TO ILLNESS FROM OTHER DOGS OR CATS IN THE SHELTER AND MAY BE INCUBATING AN ILLNESS  BUT HOLD AND RELEASE CARRMISSOURI FROM ANY AND ALL RESPONSIBILTY REGARDING THE HEALTH OF THE DOG OR CAT. THE DAY WE TAKE OWNERSHIP OF THE ADOPTED DOG OR CAT I/WE ARE RESPONSIBLE FOR PROVIDING AND PAYING FOR ANY AND ALL VETERINARY CARE THAT THIS DOG OR CAT MAY NEED. I/WE AGREE TO FOLLOW UP WITH OUR VETERINARIAN TO OBTAIN FUTURE VACCINATIONS AND/OR MEDICATIONS NEEDED FOR THIS PET. I/WE AGREE TO PROVIDE DAILY PROPER CLEAN WATER AND FOOD FOR THIS PET AS WELL AS PROVIDE PROPER EXERCISE FOR THIS PET. I/WE UNDERSTAND THAT WHEN ADOPTING A DOG OR CAT ESPECIALLY RECENTLY RELEASED FROM A KILL SHELTER ENVIRONMENT, THERE ARE CERTAIN RISKS INVOLVED AND CARRMISSOURI AND VOLUNTEERS OF CARRMISSOURI HAVE PROVIDED ALL THE INFORMATION THEY HAVE BEEN GIVEN BY THE SHELTER. I/WE HEREBY GIVE CARRMISSOURI PERMISSION TO PERFORM A FULL CRIMINAL BACKGROUND CHECK THAT INCLUDES CREDENTIALING AND VERIFICATION OF ALL INFORMATION THAT I/WE HAVE PROVIDED ON THIS ADOPTION APPLICATION. 


** PRINT YOUR FULL NAME HERE AS YOUR APPROVAL: __________________________________. I/WE AGREE THAT THE ADOPTION FEE IS 100% NON-REFUNDABLE. I/WE AGREE THAT IN THE EVENT OF A DISASTER WE ARE 100% RESPONSIBLE FOR THIS PET PRIOR, DURING AND AFTER A DISASTER AND AGREE TO DO EVERYTHING IN MY/OUR POWER TO KEEP THIS PET SAFE FROM DANGER. I/WE UNDERSTAND THAT IT IS OUR RESPONSIBLITY TO READ ALL INSTRUCTIONS THOROUGHLY AND SUBMIT A COMPLETE APPLICATION INCLUDING REQUIRED DOCUMENTS IF THE INFORMATION DEVELOPED BY CARRMISSOURI REQUIRES SUBMISSION OF ADDITIONAL DOCUMENTATION. FAILURE TO DO SO MAY CAUSE MY/OUR APPLICATION TO BE CONSIDERED INCOMPLETE WHICH WILL RESULT IN TERMINATION OF THE APPLICATION. I/WE UNDERSTAND FAILURE TO PROVIDE OR DISCLOSE PERTINENT INFORMATION WILL CAUSE SUBSTANTIAL DELAYS IN THIS PROCESS AND MAY RESULT IN DENIAL OF APPLICATION. I/WE UNDERSTAND THAT COMPLETING AN APPLICATION DOES NOT GUARENTEE ANY ADOPTION WITH CARRMISSOURI. I/WE UNDERSTAND AND AGREE THAT ADOPTER MUST BE 21 YEARS OR OLDER TO ADOPT AN ANIMAL FROM CARRMISSOURI AND A LEGAL UNITED STATES CITIZEN. (CARRMISSOURI RESERVES THE RIGHT TO DENY ANY APPLICATION WITHOUT PROVIDING ANY REASON, ALTHOUGH THIS IS EXTREMELY RARE.)

 

ADOPTERS ACCEPTANCE OF THE ABOVE: PRINT FULL NAME:     

ADOPTERS ACCEPTANCE OF THE ABOVE: PRINT TODAY DATE:


---PLEASE SEND COMPLETED ADOPTION APPLICATION TO CARRMISSOURICAMPUS@GMAIL.COM.


We currently have 2 ways you can submit an adoption application to us. 1) Copy and Paste the below online adoption application into your email message. Complete the questions and then send us the adoption application to: carrmissouricampus@gmail.com.  Be sure to put into the subject line ADOPTION APPLICATION.  2) send an email to carrmissouricampus@gmail.com requesting a adoption application in PDF format. At this time we can only accept adoption applications via email system; we do not have a fax machine.  If you have any issues or questions, please contact us at carrmissouricampus@gmail.com or 816-697-5055.  Thank you.

ADOPTION APPLICATION

CARRMISSOURI


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homeless animals! SPAY AND NEUTER PETS!