Pet Adoption Application - Humane Society of Northwest Montana

Humane Society of Northwest Montana

Home of the Charlotte Edkins Animal Adoption Center

Fill out and submit adoption application below or download and print it here.

Pet Name

Application for (Name of Pet):

Contact Information

Applicant's Name:

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

Spouse's First Name:

Home Phone:

Cell Phone:

Please be sure mailing address is accurate as this is where your adoption paperwork will be mailed.

Mailing Address:

City:

State:

Zip:

Physical Address, if different:

Email Address:

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

YesNo

Would you like to receive email from Hill’s Pet Nutrition, Inc. ®/™ ?

YesNo

Adoption Information

Is the pet you are applying for a:

DogCatPuppyKitten

Have you owned a dog/cat previously?

YesNo

Have you adopted an animal from here before?

YesNo

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

About Your Home

Does your residence have a fenced yard?

YesNo

Do you own the property where you reside?

YesNo

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