Date Name Address

City State Zip

Primary Phone Alternate Phone Email Address

Animal Selected

The animals available for adoption came here from a variety of sources.  They are all examined upon entry and their health is routinely monitored while at the shelter.  Cats are all tested for feline leukemia and dogs are tested for heartworms.   Our adoption fee covers spay/neuter, vaccinations, worming, flea and tick prevention, heartworm prevention, microchipping and treatment of any medical conditions known to us.

The animal’s welfare is our foremost consideration.  A consultation process is designed to help us determine if the adoption is in the animal’s best interest and to assist you in finding the animal most compatible with your lifestyle.  We reserve the right to refuse adoption to anyone. 

Adoption fees are cash or check made payable to Nassau Humane Society.
Dogs - $120
Cats  - $75


I am interested in adopting a

My reason for adopting is

My experience with pets is

My new pet will need to get along with

My pet’s personality should be


If approved for adoption, do you agree to allow NHS staff to

Do you agree to take your new pet to a licensed veterinarian within 10 days of adoption to verify the health condition of the pet and to establish heartworm prevention treatment? 


(This is to verify that NHS has offered a healthy pet for adoption and to establish heartworm preventative.)

Do you agree to continue heartworm and flea prevention? 

Please note there is a minimum 24 hour processing period prior to approval for adoption once you select a pet. During these 24  hours NHS staff will review and do all veterinarian/home/ landlord verifications on the information you have provided in this application.

Please understand it will take time, patience, and effort for both the adopter and the adopted pet to adjust to new surroundings.

I agree, if approved for adoption, that I will not hold Nassau Humane Society liable for any direct or consequential damage arising from the adoption. I further agree to follow up ion all vaccinations and heartworm preventative as recommended by my veterinarian. I agree to allow follow-up calls by Nassau Humane Society assess my new pet's progress.

I further understand Nassau humane Society has the right to nullify this agreement and confiscate the animal if there is evidence of improper care and/or lack of current medical services provided by a licensed veterinarian, resulting in the pet's health and welfare being jeopardized.

I certify that all information I have provided is true to the best of my knowledge and understand that any false or misleading information will result in nullifying this adoption.

I have read and understand the General Information Sheet as part of this application. I further understand in the event the adopted pet is surrendered to a shelter, it must be surrendered back to Nassau Humane Society.

You must agree to the above terms to submit an application.

I Agree




Thank you for considering one of our wonderful pets for adoption. Nassau Humane Society takes pride in offering to the best of our ability, healthy sound pets for adoption. Information we have on most of our animals are based on an educated, experienced best guess. We have tried to provide your with our estimate of age, breed/s and disposition as we have observed while in our care.

Adoption fees are listed below and include the following:

K-9 - $120.00
Feline - $75.00
  • Spay/Neuter
  • Rabies Vaccine
  • Regular Wormings
  • Regular Flea Treatment
  • Test for Heartworm & Lyme Disease
  • Current on 5 or 7 way vaccine
  • Regular Heartworm Preventative
  • Microchip
  • Spay/Neuter
  • Rabies Vaccine
  • Regular Wormings
  • Regular Flea treatment
  • Test for FIV/FeLuk
  • FVRCP Vaccine
  • Microchip

Please note: One worming does not kill all worms and one set of shots does not protect the pet from disease. Your pet may require additional shots and worming . This would be at your expense and should be discussed at the 10-day visit with your veterinarian.

RETURN POLICY: We do our very best to place only healthy sound animals for adoption. Animals that have come in from the streets and with unknown backgrounds can become ill as their immune system is not 100%. You are required to have your new pet examined by your veterinarian within 10 days of the completed final adoption. Please remember most puppies need to be observed for any sign of loss of appetite, loose or discoloring in stool or any change in behavior. If your new pet becomes ill, you have the option of returning the pet to us or having the pet treated at your expense by your veterinarian. If you choose to return the pet, we ask that you return it to Nassau Humane Society. A refund will be given no later than the 14th day of the final adoption, however, no refund will be granted after the 14th day. If you return a pet for any reason other than a health issue, more than 30 days form the final adoption you will be required to pay a $40.00 surrender fee and sign all necessary release forms relinquishing all rights aof the pet back to Nassau Humane Society.