Cat Surrender Questionnaire | Lawrence Humane Society

Pre-Relinquishment Questionnaire (Cat)

Lawrence Humane Society only accepts animals from within our jurisdiction of Douglas County. If you are a Douglas County resident in need of assistance, please complete the following form. You should submit one form per pet you are requesting to surrender or relinquish to Lawrence Humane Society.
Please complete the following information to request a pet surrender appointment with Lawrence Humane Society. One form should be completed for each pet.

It is important that the answers provided are honest and detailed. The information you provide will help Lawrence Humane Society provide adequate care for the pet and aid in our ability to determine the best outcome for the pet, including placement options and matchmaking for adoptions.

Once you have submitted your questionnaire, a Community Caseworker will contact you to gather any additional information, discuss what options are best for the pet, and/or schedule an intake appointment for the pet to be surrendered to Lawrence Humane Society.

If you have any questions, please contact the Pet Resource Center at 785-371-0473 or help@lawrencehumane.org. Thank you.
First and Last Name:*

First Name of Owner or GuardianLast Name of Owner or Guardian
Preferred Name:
Pronouns:

She/Her/HersHe/Him/HisThey/Them/TheirsOther
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:*
Please enter a valid phone number.
Alternate Phone:
Please enter a valid phone number.
Email:*
example@example.com
Preferred method of contact:*

PhoneEmail
Preferred time of contact:*

MorningAfternoonNo preference
Preferred language:*

EnglishSpanishOther
Have you used Lawrence Humane Society (LHS) services before or adopted a pet from LHS?*

YesNo

Cat Information
Cat Name:*
Breed: (Select one)*

Domestic shorthairDomestic medium hairDomestic long hairOther
Age and/or Birthday:*
Weight:*
Sex:*

Male - neuteredFemale - spayedMale - intactFemale - intactUnknown
Color(s):*
Distinguishing Markings:*
How long have you had your cat?*

Other Information
Is there any other information you would like us to know about your pet that may help us find the best placement options for this animal?*

YesNo
Other information for best placement options:*

Euthanasia
The Lawrence Humane Society strives to find positive outcomes for each animal that enters the shelter, however there are some instances where we may elect to euthanize an animal. Reasons include but are not limited to severe medical conditions that cannot be effectively treated or managed, or unsafe behavior.
I understand my pet may be euthanized if deemed appropriate by the Lawrence Humane Society staff.*

I agree
Would you like to be notified if the animal you are surrendering is at risk of euthanasia?*

Yes, I would like to be notified.No, I do not wish to be notified.
I understand that the Lawrence Humane Society does NOT guarantee to provide notification prior to euthanasia, even if I indicated above that I would like to be contacted.*

I agree

Agreement
I am the owner or authorized agent/designee for the owner of the animal described above.*

I agree
The information provided in this questionnaire is accurate and true to the best of my knowledge.*

I agree
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Pre-Relinquishment Questionnaire (Cat)