Dog Assistance Request

We're happy to have our support services team reach out to you for additional assistance, but first we need to gather more information about you and your dog.

Please note, if you have already filled this form out before for the same dog, DO NOT submit it again. If you need additional assistance, please reach out via email.
Pet Guardian's Information
Your Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Email *
example@example.com
What concerns can we help you address with your dog? *

Dog food, supplies, or veterinary care (spay/neuter, vaccines, microchips) Behavior support Rehoming support
What resources can we provide to help you resolve your concerns? *

We're glad the resources provided were helpful. If you wish to receive an email copy of these documents, please enter your email address and submit this form. Otherwise you may exit any time.
Email *
example@example.com
Thank you for providing the information we need to best support you. Upon submission of this form, please follow the link to schedule a PHONE consultation with a Pet Guardian Support Services team member. THIS IS NOT AN APPOINTMENT TIME TO BRING YOUR DOG TO THE SHELTER.
I certify that the above information is complete and truthful to the best of my knowledge. *

I agree
I understand that there may be a waiting period before my dog is able to enter the shelter. I will consider every alternative to relinquishment and to utilize fully the resources made available before surrendering my pet to the shelter. *

I agree
I certify that I am at least 18 years old, and I am the legal owner of this pet. I understand that if I relinquish my animal to Central Missouri Humane Society, I will not be able to determine its final placement, and I understand that my pet may be adopted, sent to a foster home while awaiting adoption, transferred to another organization, or humanely euthanized (in the event of untreatable medical or behavioral conditions). I understand that if I seek to reclaim this animal once it has been placed up for adoption, I will have to go through the regular adoption process. *

I agree
Your date of birth *
Your Driver's License number *
Should be Empty:

Instead of . . .	Try . . .
Needs a lot of exercise	Will make a great running buddy
Is aggressive towards children	Would do great with a mature family
Needs a lot of attention	Loves to be around people

Dog Assistance Request Form

Based on your selection(s), we've identified these resources to assist you:

Pet Guardian's Information