Adoption Application

Name *

First

Last

Email *

Phone *

Your Address *

Address Line 1

City

State

Age *

Drivers License#

Are you employed or retired? *

Yes I am employed
No I am retired

Employer

Employer Address

Address Line 1

City

State

Employer Phone

Emergency Contact Name *

Address

Address Line 1

City

State

Additional Information

How long have you lived at your current address? *

Do you rent or own your home? *

Rent
Own

Are you allowed to have pets? *

Yes
No

How will you contain your pet? *

Do you have children in your home? *

Yes
No

If so how many and what are their ages?

Do you have any other pets? *

Yes
No

If so please tell us some information about them.

Have your pets been tested for heartworms?

Yes
No

If so please tell what kind of heartworm preventative is your pet taking?

If you have cats have they been tested for Feline Leukemia and FIV?

Yes
No

What kind of identification do your pets have?

Tag
Microchip
Nothing

Are they all spayed/neutered?

Yes
No

If not then why?

Have you previously owned a pet? *

Yes
No

If so please tell us what.

Do you have a Veterinarian?

Yes
No

Who is your veterinarian?

Veterinarian's Phone

How do you feel about having a pet spayed or neutered? *

Why do you want to adopt a pet from the Humane Society of Etowah County? *

What you believe is a pet owner's responsibility? *

How should we contact you? *

Phone
Email

I certify *

That all information contained herein is true and acknowledge that giving false information will void the adoption.

Apply online using the form below or click here for a printable version

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