• 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.

    Questions? Contact the Pet Resource Center at help@lawrencehumane.org. 

  • 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?*
    • Cat Information 
    • Breed: (Select one)*
    • Sex:*
    • Reason for Re-homing Your Cat 
    • What is the reason for needing to re-home your cat?*
    • Have you taken any steps to resolve or remedy the reasons that are causing you to re-home your cat?*
    • 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 cat?*
    • Cat Medical Information 
    • Has your cat been vaccinated in the last 12 months?*
    • Is your cat microchipped?*
    • Has your cat ever been tested for Feline Leukemia (FeLV)?*
    • What was the result of the FeLV test?
    • Has your cat ever been tested for Feline Immunodeficiency Virus (FIV)?*
    • What was the result of the FIV test?
    • Is your cat declawed?*
    • Is your cat on any medications or special diet?*
    • Does your cat have any allergies or medical conditions?*
    • What do you feed your cat?*
    • Basic Information 
    • Where did you get your cat from?*
    • Where has your cat been living primarily?*
    • Has your cat ever been outdoors?*
    • General Behavior 
    • How long is your cat left alone, without people, on a typical day?*
    • Is your cat litter box trained?*
    • When your cat plays, does he/she typically:*
    • Is your cat afraid of anything?*
    • Is your cat allowed on the furniture?*
    • Does your cat scratch furniture or use scratching posts / items?**
    • Behavior Around Other Animals 
    • What other animals has your cat lived with? Select all that apply.*
    • Has your cat ever attacked another animal resulting in severe injury or death?*
    • Behavior Around People 
    • Has your cat 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 cat ever inflicted a bite to a person that broke the skin?*
    • What types of people has your cat lived with?*
    • Has your cat ever reacted to a person by hiding, hissing, swatting, or biting towards any of the following populations:*
    • Has your cat ever inflicted a serious bite to a person?*
    • Has your cat ever shown any of the following behaviors when trying to pick them up or hold them, when attempting to pet them, while petting them, or while trying to trim their nails?*
    • 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?*
    • 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: