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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