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Rutherford County Humane Society Dog Adoption Application

Please complete this form for dog adoption. Please print out a copy for yourself and click the Submit Form button when you are done. We will get back to you as soon as possible.

Please note: Please note: All of Our Pets are located in Western North Carolina. But transport can be arranged as far North as Maine.


Special Instructions for adoptions of Pets under the age of 4 months

For pets under the age of 4 months the adopter will be responsible to continue the "baby" shot (the basic distemper vaccine) and pet deworming at 3 week intervals. They will need to have the rabies vaccine done at 4 months of age.

As noted in the adoption contract, #17, the adopter agrees to have the pet altered (spay or neuter) at the earliest time his vet recommends. Adopter will inform RCHS when the vet can submit written confirmation that the surgery has been completed. At that time, the adopter will be reimbursed the amount RCHS would have paid to perform the altering in Rutherford County, NC.  For out of state adopters we send a rebate: cats: $50 female, $30 male, dogs $75 female, $70 male. Adopters would be well advised to look for a spay/neuter clinic in their area to save money. For pets staying near Rutherford County, we pay for the spay/neuter surgery at some of the local vets (check with us to be sure which ones.) For adopters near Asheville we use Humane Alliance and for adopters in SC we use Animal Allies. 

Special Instructions about transport

We are in North Carolina. 
All our pets are in foster homes. We send our pets once a week on transport to a location near the adopter's home. The transport leaves every Friday from here to Saturday delivery up there! There is a transport fee - $100 up to NY City and $125 north of NY City and above.

You can talk to the pet's foster about personality, etc. before you make a decision if you would like to. Please fill out our application online and we will be in touch with you soon!

Please note: Please note: All of Our Pets are located in Western North Carolina. But transport can be arranged as far North as Maine.

Welcome to Rutherford County Humane Society’s dog adoption program. We request the following information so that we can assist you in the selection of a new dog. This form and a consultation with a Rutherford County Humane Society representative are designed to help you find the dog most compatible with your lifestyle.

To be considered as an adopter, you must:
• Be 21 years of age or older
• Have identification showing your present address
• Have the knowledge and consent of your landlord
• Be able and willing to spend the time and money necessary to provide medical treatment
and proper care of the dog

Please complete this form and print out a copy for your records. Then click on the
Submit Form Button. We will get back to you as soon as possible.

Name of Dog:
1. Name of Applicant:
Name of Spouse_Partner:
2. Applicant Address. Please provide Street Address, City, State, Zipcode
3. How long at this address?
4. Home Phone:
Cell Phone: Work Phone:
5. Email Address:
6. Employer and address and phone:
Spouse Employer and address and phone:
7. Occupation:
Spouse_Partner Occupation:
8. Number of Children Living in this household. Give Names and Ages:

Number of Adults living in this household. Give Names, ages, and Occupations:

Is anyone living in this household either pregnant or trying to become pregnant? YesNo
9. What type of environment do you live in?
10. What kind of housing do you live in?
11. Do you rent or Own? RentOwn
If you rent, do you have permission from your landlord to own a companion animal?
A pet that is under 25# Over 25#

What is your landlord's name, address, and phone number?

12. What other dogs/cats have you previously owned and what happened to them? (state pet's name, age, if spayed/neutered, reason for giving up/cause of death):

What other dogs/cats currently live in your home: (please list: names, breed, sex, age, any health issues they may have & if spayed/neutered):

13. Are there any other types of animals currently living in your home? (if so, describe):

14. What do you know about the breed in question? ( It is required that you research this breed's traits/habits)?:

15. Are there any specific habits/problems you are not willing to work with? If so, please specify:

16. Gender Preference:

MaleFemale No Preference

17. Do you have a fenced-in yard & is it connected to the house? (entire yard, front yard only, backyard& attached to back door, etc):

What is the height & dimensions of the fenced-in area (please, be specific, as this info is REQUIRED & PERTINENT to the approval of your application):

Please, describe your fencing materials(chain link, wooden stockade, vinyl rail...2, 3 or more rails.

Is it reinforced with wire./what kind of wire? wire...chicken/field/hog....or upright slats...etc).

What type of gates (describe as you did in above question):

Can they be opened by children? YesNo

If you don't have a fenced-in yard, how will the animal be exercised and allowed to eliminate?

18. Who will supervise outdoor activities?

19.Do you have a: Pet door, Kennel run, Dog house, Stake, Tie-out or cable-run,Crate, or None. Please describe in the box below:

20. Do you have a swimming pool? YesNo

Is it fenced-in separately from the rest of the yard?

21. What member of the family will be taking the MAJOR responsibility for the care of this animal?

22 Does anyone in your family have allergies to ANY animal? YesNo

23 Has anyone in your household had a problem with impulse control? Please explain:

24 What are your plans for this animal? Protection/guard, companion, child's pet, pet therapy, agility/fly ball, obedience, herding, ranch work, other? Please describe:

25 (a) Have you ever trained a dog in obedience classes?

(b) Are you planning on taking your adopted dog to an obedience class?

26 Have you ever sold, given away or surrendered a pet? If so, please provide details of situation:

27 (a) How much time are you willing to give the dog to adjust to it's new environment & family members?

(b) This dog may not be housebroken. Are you willing to take the time to work with the animal?
(c) Do you understand that if this dog is any kind or variation of a hound breed, you will need to have a securely fenced-in yard or promise to keep the dog on a leash at all times whenever it is outdoors? YesNo

28. Will the animal live in the home? If not, where will it live?

29 What type of shelter will be provided when the dog is outside (doghouse/patio/decking overhang, etc):

30 Where, exactly, will the animal sleep at night and be kept when there is no one at home (i.e.., crated, free roam of home, laundry/kitchen area, fenced-in yard, etc):

31 (a) On the average, how long will the animal be left alone during the day?

(b) What is the activity level of your household? Busy, visits by friends, meetings, children, parties at home, noisy-TV, stereo, machinery, tools, kids playing; moderate-normal comings and goings; quiet-homebodies, few guests. Please describe in the box below:

32 Do you believe in dog crates? If so, for what exact purpose(s)?

33 If you had to move & your new landowner does not allow pets, what will you do with your companion animal?

34 When you go on vacation, will your pet accompany you or who would care for it?

35 Under what condition(s) would you consider giving up your companion animal?

36 (a) who is the veterinarian you currently use, or used for your previous animal's health issues (IF used within past 5 yrs)? Please provide the veterinarian's/Pet Hospital's name. address. and phone number:

   (b) What type of Heartworm Prevention do you use?

37 (a) How will your animal travel to the vet, or other places(i.e.,crated, doggie seatbelt, loose in a car/van, tethered or in crate or in box in bed of truck?

37 (b) Are you willing to allow an RCHS's representative to periodically visit your home? If not, why?

40 List names, addresses, phone numbers & email addresses of 3 NON-RELATED personal references, whom you have known for at least 3 years:

40 (a) Reference 1

40 (b) Reference 2
40 (c) Reference 3

41 If you are disabled and should have any special needs please be sure to let us know; this will help us find the BEST companion for you and your needs:

42 What arrangements have you made for your companion animal(s), if you could no longer care for them (i.e.., moving overseas, extended hospital stay, nursing care facility, death)?

43 And, finally, please tell us a little about yourself and why you feel you could provide a good home for a rescued companion animal:

****Our goal in rescuing and re-homing animals is to provide them with a loving home for the rest of their lives. The adoption fee covers some their medical costs associated with the animal, medical and daily care during their foster period and any special care.
All animals adopted by our group MUST BE spayed/neutered prior to finalizing the placement. Most of RCHS's adoptables are in foster care in Rutherford Co, NC.
Your signature below states that you understand any future medical costs are your responsibility and we have made full disclosure regarding our & our vet's knowledge of the health of the animal.
Sometimes, for reasons beyond anyone's control, the adoption does not work out. In this case, the animal must be returned to RUTHERFORD COUNTY HUMANE SOCIETY (RCHS) at the adopter's expense, although RCHS will try to arrange a rendezvous to minimize the adopter's inconvenience. Adoption fees may be refundable, at the discretion of RCHS.
By signing this application, I attest to the fact that I am 21 years of age or older, and that the above information provided is correct, to the best of my knowledge. RCHS and adopter agree to accept typed in names (electronic signatures acknowledging approval of this agreement, to be the equivalent of actual signatures of the parties.


Signature of Spouse _Partner
After completing this application, please click on the 'submit form' button at the top of this form.