Pet Adoption Application - Humane Society of Northwest Montana

Thank you for completing an adoption application. All applications are worked in the order they came in, confirming information and gathering records as applicable. Please understand that the verification process does not always follow the same timeline, as follow-up calls and emails sometimes need to occur. Additionally, pets that have known quirks or special health needs will be placed with the best match, not necessarily the first application. Thank you for understanding!

Application for (Name of Pet or type of dog/cat):

CONTACT INFORMATION

Applicant's Name:

First

Last

(Applicants must be at least 18 years old; proof of identification required)

Home Phone:

Cell Phone:

Physical Address:

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address, if different:

Email Address:

Would you like to receive email from the Humane Society of NW Montana?

Yes
No

ADOPTION INFORMATION

Is the pet you are applying for a:

Dog
Cat
Puppy
Kitten

Have you owned a dog/cat previously?

Yes
No

Have you adopted an animal from here before?

Yes
No

If yes, what was the Pet’s name at the time of adoption?

Have you ever surrendered an animal to an animal shelter?

Yes
No

If yes, please explain:

ABOUT YOUR FAMILY

Are there children in the household?

Yes
No

If yes, children's ages:

Have your children lived with pets before?

Yes
No
N/A

Does any member of your family have allergies to animals?

Yes
No
Don't know

Are there any dogs currently living in your home?

Yes
No

If yes, please list the dog's names:

Are there any cats currently living in your home?

Yes
No

If yes, please list the cat's names:

Are all the dogs and cats in your home current on their rabies vaccination?

Yes
No

(verification is required)

Name of your Veterinarian (clinic name):

Clinic Phone Number:

Clinic City, State, ZIP

ABOUT YOUR HOME

Does your residence have a fenced yard?

Yes
No

Do you own the property where you reside?

Yes
No

If your residence is owned by someone other than yourself, verification for pets on the premises is required from the property owner(s)/landlord(s):

If you rent your home, please provide either (1) a copy of your lease agreement, or (2) your Landlord’s name and phone number:

If you live with friends or family, please provide either (1) a copy of their lease agreement, or (2) their name and phone number:

I certify that the information I provided in this application is true and complete to the best of my knowledge. I authorize the Humane Society to verify all information I have supplied. I also give my consent for the release of information about my lease agreement and my pet’s rabies vaccination. I understand and agree that the Humane Society has complete discretion as to whether or not it will proceed with any adoption. Any untrue statements I make in this Application may result in refusal of adoption.

I acknowledge and agree to the above statements.

I understand that clicking the "Submit" button below is equivalent to signing this application form.

I acknowledge and agree that submitting is equivalent to signing this form.

Humane Society of Northwest Montana

Home of the Charlotte Edkins Animal Adoption Center

CONTACT INFORMATION

ADOPTION INFORMATION

ABOUT YOUR FAMILY

ABOUT YOUR HOME