Canine Intake Form

  • Person's Information

  • Animal's Information

  • If you are returning a dog that was adopted from LRHS for behavioral issues and did not utilize the services of a professional dog trainer to work on these issues (as outlined in the adoption contract). A $50 breach of contract fee will apply.

    By initialing this form, you are authorizing that you are the rightful owner of this pet. You are agreeing to sign over full ownership of this animal to the Lakes Region Humane Society (LRHS). You understand that it is the intention of LRHS to vet and place this animal in suitable home. By signing you understand that due to diminishing health or aggressive behavior, euthanasia may be considered. You are giving LRHS full custody of this animal and the right to release this animal from suffering if recommended by a Veterinarian.

  • By initialing here you agree to the above terms, and that all information provided is accurate.
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  • Canine Profile

  • Household History

    Check all that apply.
  • Possessive History

  • How does your dog react when you or another family member...

  • Medical History and Behavior towards the Veterinarian

  • Behavior History

  • Is there anything you want a new family to know about your dog’s interaction with: