Crisis Pet Retention Fund Application
Please answer the questions below to the best of your ability. The information you provide will be kept confidential. Please be sure to provide your phone number and/or email address so that Lawrence Humane Society staff can contact you as soon as possible after submitting this form.
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My name is: *
My preferred pronouns are:
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My email address is (will not be shared):
My phone number is (will not be shared):
My zip code is: *
My address is (will not be shared):
My preferred language is:
I am looking for support with the following (check all that apply): *
Tell us more about you, your pet(s), and your situation:
Have you been economically impacted by COVID19? *
How did you learn about the Crisis Pet Retention (CPR) Fund program?
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