Adoption Application Apply online using the form below or click here for a printable version Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *Your Address *Address Line 1CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateAge *Drivers License#Are you employed or retired? *Yes I am employedNo I am retiredEmployerEmployer AddressAddress Line 1CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateEmployer PhoneEmergency Contact Name *AddressAddress Line 1CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateAdditional InformationHow long have you lived at your current address? *Do you rent or own your home? *RentOwnAre you allowed to have pets? *YesNoHow will you contain your pet? *PenIn the houseFenced in yardKennelOtherDo you have children in your home? *YesNoIf so how many and what are their ages?Do you have any other pets? *YesNoIf so please tell us some information about them.Have your pets been tested for heartworms?YesNoIf 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?YesNoWhat kind of identification do your pets have?TagMicrochipNothingAre they all spayed/neutered?YesNoIf not then why?Have you previously owned a pet? *YesNoIf so please tell us what.Do you have a Veterinarian?YesNoWho is your veterinarian?Veterinarian's PhoneHow 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? *PhoneEmailI certify *That all information contained herein is true and acknowledge that giving false information will void the adoption.CommentSubmit