Humane Society Pet Rescue and Adoption Center

Adoption Application

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

  1. Your Personal Information

  2. Full Name(*)
    Please type your full name.
  3. E-mail Address(*)
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  4. Address:(*)
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  5. City(*)
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  6. State(*)
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  7. Zip Code(*)
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  8. Phone(*)
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  9. Age(*)
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  10. Drivers License(*)
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  12. Your Employer Information

  13. Employer(*)
    Please type your full name.
  14. Employer Address(*)
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  15. Employer City(*)
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  16. Employer State(*)
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  17. Employer Zip Code
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  18. Employer Phone(*)
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  20. Your Emergency Information

  21. Emergency Contact Name(*)
    Please type your full name.
  22. Address:(*)
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  23. City(*)
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  24. State
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  25. Zip Code
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  26. Phone(*)
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  28. Additional Information

  29. How long have you lived at your current address? (*)
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  30. Do you Own or Rent your home? (*)
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  31. Are you allowed to have pets?(*)
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  32. How will you contain your pet?(*)
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  33. Number of children in home(*)
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  34. Ages of children(*)
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  35. Do you have any other pets? (*)
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  36. What types of pets and how many?
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  37. What are their names and ages?
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  38. Are they all spayed/neutered? (*)
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  39. If not, why?
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  40. What kind of identification do your pets have?
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  41. Have you previously owned a pet? (*)
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  42. What types of pets?
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  44. Who is your veterinarian?
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  45. Veterinarian's Phone
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  46. Have your pets been tested for heartworms?(*)
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  47. What kind of heartworm preventative is your pet taking?
    Invalid Input
  48. Have your cats been tested for Feline Leukemia and FIV? (*)
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  49. How do you feel about having a pet spayed or neutered?
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  50. Why do you want to adopt a pet from the Humane Society of Etowah County?
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  51. Please explain what you believe is a pet owner's responsibility.
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  52. Any comments about the Humane Society of Etowah County?
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  53. I certify that...
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  54. How should we contact you?
  55. Anti-Spam Verification
    Anti-Spam Verification
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  56.   

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