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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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* Required
My name is:
*
Your answer
My preferred pronouns are:
She/her/hers
He/him/his
They/them/theirs
Other:
Clear selection
My email address is (will not be shared):
Your answer
My phone number is (will not be shared):
Your answer
My zip code is:
*
Your answer
My address is (will not be shared):
Your answer
My preferred language is:
Your answer
I am looking for support with the following (check all that apply):
*
Pet deposit/pet rent
Essential pet supplies (pet food, cat litter, dog crate, etc.)
Essential veterinary care (vaccinations, spay/neuter, microchips, flea/tick treatment, etc.)
Emergency veterinary assistance
Behavior consulting
Emergency temporary pet boarding
Other:
Required
Tell us more about you, your pet(s), and your situation:
Your answer
Have you been economically impacted by COVID19?
*
Yes
No
Required
How did you learn about the Crisis Pet Retention (CPR) Fund program?
Your answer
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