Adoption Application
Name:   Age:
Email Address:   Driver's License #:
Home Phone:   Cell Phone:
Address:
City:
State:   Zip:
Employer:   Employer's Phone:
Address:
City:
State:   Zip:
Emergency Contact Name:   Phone:
Address:  
City:  
State:   Zip:
How long have you lived at your current address?
 
Do you Own or Rent your home? Own Rent  
  • Are you allowed to have pets?
 Yes No  
  • Landlord's Name:
   Landlord's Phone:
Where will this pet live? Indoors Outdoors  
Do you have a fenced in yard? Yes No  
  • How will you contain your pet?
Number of children in home:   Ages of Children:
Do you have any other pets? Yes No  
  • What types of pets and how many?
  • What are their names and ages?
  • Are they all spayed/neutered?
 Yes No  
    • If not, why?
  • What kind of identification do your pets have?
  • Have you previously owned a pet?
 Yes No  
    • What types of pets?
Who is your veterinarian?   Veterinarian's Phone:
May we contact your veterinarian? Yes No  
 
Have your pets been tested for heartworms? Yes No  
What kind of heartworm preventative is your pet taking?
 
Have your cats been tested for Feline Leukemia and FIV? Yes No  
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?
Please explain what you believe is a pet owner's responsibility.
Any comments about the Humane Society of Etowah County?
Required.
 I certify that all information contained herein is true and acknowledge that giving false information will void the adoption.