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About LCHS
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Adopt A Dog
Adopt A Cat
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About LCHS
Adopt
Adopt A Dog
Adopt A Cat
Application
Resources
Surrender A Pet
Volunteer
Events
Donate
Surrender A Pet
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*
" indicates required fields
Please answer all questions honestly and completely. This is for your dog’s benefit as well as ours. We want to find the best match possible for your dog. Being dishonest or omitting information only hurts your dog.
Are you the owner?
Yes
No
Owner Info
Name
*
First
Last
Email Address
*
Phone Number
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Are you a resident of Lawrence County, PA?
Yes
No
Are you surrendering a dog or cat?
*
Dog
Cat
Where did you acquire the pet from?
*
Why are you wanting to surrender?
Pet Info
Name
*
Age
Breed
Color
Male/Female
Male
Female
Spayed/Neutered
Yes
No
Declawed
Yes
No
Size
Small
Medium
Large
Is the pet indoor or outdoor?
Indoor
Outdoor
Does the pet have any health issues or allergies?
Yes
No
If yes, please describe
Does the pet require medications, special diet, and/or frequent vet visits?
Yes
No
If yes, please describe
Photo of the pet
Accepted file types: jpg, gif, png, pdf, webp, jpeg, Max. file size: 300 MB.
Temperament
Has the pet ever bitten anyone?
Yes
No
If yes, please explain what caused the bite and the severity
*
Does the dog live and/or have lived with the following:
Other dogs
Cats
Children
Farm animals
Other small animals
Does the cat live and/or have lived with the following:
Other cats
Dogs
Children
Farm animals
Other small animals
If yes, how did they do with them?
Fears
Please check any of the following that your dog has issues with or fear of:
Bath
Nail trim
Car rides
Men
Fireworks
Storms
Strangers
Vet visits
Leash walking
Other
Please check any of the following that your cat has issues with or fear of:
Grooming
Nail trim
Men
Fireworks
Storms
Strangers
Vet visits
Other
Please explain the behavior with the fear:
Does your dog have any behavioral issues with:
Food aggression
Resource guarding
Separation anxiety
Does your cat have any behavioral issues with:
Not using the litter box
Doesn't like picked up
Are they destructive?
*
Yes
No
Veterinarian's Name
*
Veterinarian's Phone Number
*
By signing below, I agree that the above information is true to the best of my knowledge:
Signature
*
Date
*
MM slash DD slash YYYY