• Pre-Relinquishment Questionnaire (Dog)

    Please complete one form per pet to request pet surrender services.

  • Lawrence Humane Society accepts owned pets only from Douglas County, Kansas. Exceptions may be made on a case-by-case basis for animals previously adopted from LHS with verifiable records.

    To begin the surrender request process, owners must submit an online pet surrender questionnaire for each animal. A completed form is required before an intake appointment can be scheduled, and appointments are required to relinquish an owned pet.

    To give every pet the best chance of success in our care, we rely on accurate information about their background. Details about living environment, behavior, medical history, and socialization help our team understand each pet’s needs, provide appropriate care, and determine the best placement options. Please ensure all answers are honest and accurate.

    After you submit the questionnaire, a Pet Resource Center Community Caseworker will contact you to gather any additional information, discuss available options, and/or schedule your intake appointment.

    If you have questions, please contact the Pet Resource Center at (785) 371-0473 or help@lawrencehumane.org.

    Thank you!

  • Pronouns:
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Preferred method of contact:*
  • Preferred time of contact:
  • Preferred language:*
  • Have you used Lawrence Humane Society (LHS) services before or adopted a pet from LHS?*
  • Are you the legal owner of the animal you wish to surrender?*
    • Dog Information 
    • Sex:*
    • Reason for Re-homing Your Dog 
    • What is the reason for needing to re-home your dog?*
    • Have you taken any steps to resolve or remedy the reasons that are causing you to re-home your pet?*
    • Are you interested in private re-homing as an alternative to surrendering your pet to the shelter?*
    • If we could provide you with any of the following resources, would you be able to keep your dog?*
    • Medical 
    • Has your dog been vaccinated in the last 12 months?*
    • Is your dog microchipped?*
    • Is your dog on any medication or special diet?*
    • Does your dog have any allergies or medical conditions?*
    • What do you typically feed your dog?*
    • Basic Information 
    • Where did you get your dog from?*
    • What type of dwelling is your dog used to living at?*
    • Where has your dog been living primarily?*
    • General Behavior 
    • How long is your dog left alone, without people, on a typical day?*
    • Does your dog show any of the following signs of anxiety or abnormal behavior when left alone for short periods of time? (Select all that apply.)*
    • Does your dog have experience being confined to a kennel?*
    • What type of kennel has your dog been confined in?*
    • Describe your dog's comfort level being confined to a kennel: (Select all that apply.)*
    • Is your dog pottytrained?*
    • What toys and games does your dog like? (Select all that apply.)*
    • When your dog plays, does he/she typically: (Select all that apply.)*
    • What commands does your dog know? (Select all that apply.)*
    • Is your dog afraid of anything?*
    • Is your dog allowed on the furniture?*
    • Where does your dog normally sleep at night? (Select all that apply.)*
    • Describe the way your dog is typically exercised: (Select all that apply.)*
    • Describe the yard where your dog currently resides:*
    • Does your dog escape your home or yard?*
    • Behavior Around Dogs & Cats 
    • What other animals has your dog lived with?*
    • Which types of UNFAMILAIR animals has your dog had contact with in the past?*
    • Has your dog ever growled, shown teeth, snapped at, or bitten to guard food, toys, or other objects from other animals?*
    • Behavior Around Other Animal Types (Small Animals, Livestock, Wildlife) 
    • Has your dog ever reacted to other animal types by growling, showing teeth, snapping, or biting?*
    • Does your dog usually chase or attempt to chase outdoor cats, squirrels, or other small animals?*
    • Behavior Around People 
    • What types of people has your dog lived with?*
    • Has your dog ever reacted to a FAMILIAR person (someone they know well) by growling, showing teeth, snapping, or biting?*
    • Has your dog ever reacted to an UNFAMILIAR person (a stranger or person they hardly know) by growling, showing teeth, snapping, or biting?*
    • Has your dog bitten anyone in the last ten (10) days?*
    • On what date did the bite occur?
       - -
      2 digit month, 2 digit day, 4 digit year
    • Has your dog ever growled, shown teeth, snapped at, or bitten to guard food, toys, or other objects from people?*
    • Has your dog ever shown any of the following behaviors when being bathed or brushed, having their paws wiped, nails trimmed, or having their harness or collar put on?*
    • 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?*
    • Photo of Pet 
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    • 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.

    • Would you like to be notified if the animal you are surrendering is at risk of euthanasia?*
    • Agreement 
    • Date*
       / /
      2 digit month, 2 digit day, 4 digit year
    • Should be Empty: