Canine Adoption Application

Pet ownership is a serious commitment that the entire household needs to consider and agree to before the animal is adopted. We want to ensure that each adoptive household is aware of, and willing and able to accept, the physical and financial responsibilities of pet ownership. Not everyone who desires to own a pet is ready to properly care for one. This questionnaire will assist both you and us in determining if your household is prepared to assume the role of responsible caretaker for a rescued animal. Thank you for taking the time to fill out this application.

Please allow our volunteers time to carefully review and process all applications (this can take several days and we will contact you once a decision has been made). If your application is received on a weekend or holiday, it may take longer for us to reach your veterinarian. We typically do not respond until we've had a chance to speak to all of your references. Thank you so much for considering a rescue!

(Fields with a red asterisk are required.)

Applicant info

Environment info

Adoption preferences

Problem resolution

Current & Past Pets

Veterinarian info


Please list names, email addresses, and phone numbers for three personal references, other than relatives. If you’ve had pets, include references who know the pets you have or have had, and the care that you provide for your pets:

Closing questions

If at any time an adopter cannot keep the dog, it must be returned to the Floyd County Humane Society. If the dog is not spayed or neutered at adoption, the adopter is required to alter the dog and provide a veterinary certification of altering to the Floyd County Humane Society by the date specified in the adoption contract. Dogs unaltered by the contractual date may be seized. Applicants may be subject to a background check. By signing below, I acknowledge that I have completely read this questionnaire and comprehend it fully. I know that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application or the adoption contract can result in the forfeiture of any Floyd County Humane Society animal adopted by me.

Updated 6-1-22