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 Family Are there children in the household? YesNo Children's Ages: Have your children lived with pets before? YesNo Does any member of your family have allergies to animals? YesNo Are there any dogs currently living in your home? YesNo If yes, please complete... Name: Breed: Age: Are there any cats currently living in your home? YesNo If yes, please complete... Name: Age: Are all the dogs and cats in your home current on their rabies vaccination? YesNo Name of your Veterinarian (clinic name): Clinic Phone Number: City: State: Zip: 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.