LWHA Intake Request

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LWHA Intake Request

Please note - Submitting an intake request DOES NOT guarantee that we can take an animal into the program. The following conditions must be met for an animal to be accepted:

The animal meets the mission of LWHA.
The animal is legally owned by the submitter (owner, shelter, rescue, etc.) and documentation has been provided to LWHA.
The animal is up to date on vetting (vaccinated, heartworm negative, current on prevention, spayed or neutered) and records have been provided to LWHA; OR associated fee will be required before LWHA will take possession of the animal. *exemption from fees is on a case by case basis
LWHA has the capacity to take in a new animal at the time of the request.
Owner documentation, vetting records, and a photo of the animal have been emailed to LWHA at lwha@longwayhome.org.

Email *

Owner first and last name *

Owner address *

Owner's phone number

Animal's Name *

Pet Species *

Dog

Cat

Other:

Breed (best guess) *

Gender *

Male

Female

Neutered Male

Spayed Female

Estimated Age (in years) *

Verified weight *

Has this animal been on heartworm prevention? *

Yes

When was their last heartworm test (dogs) or FELV/FIV test (cats)? *

What was the result of their last heartworm test (dogs) or FELV/FIV test (cats)? *

Negative

Positive

Unknown

When is pet available to leave for rescue? *

YYYY

Known medical issues *

None

Other:

Known behavioral issues *

None

Other:

Reason animal needs rescue *

Which of the following describes the animal you are trying to surrender? *

Not current on any vetting and not spayed//neutered ($100 surrender fee)

Spayed/neutered, but not current on vaccines or any testing ($50 surrender fee)

Current on vaccines and heartworm or FELV/FIV test, but not spayed/neutered ($100 surrender fee)

Spayed/neutered, up to date on vaccines and testing ($0 surrender fee)

Any additional notes *

By submitting this form, I attest that I am the legal owner of this animal *

I agree

I am NOT the legal owner of this animal and I won't submit this request

I understand that Long Way Home is a 501(c)(3) and operates solely on grants, public donations, and adoption fees. I understand that I will be required to show proof of records and pay any associated surrender fee based on those records for this animal.

I agree

I disagree and I won't submit this request

Clear selection

As the legal owner of the animal described below, hereby authorize LONG WAY HOME ADOPTABLES to take custody of said animal. I understand this animal may be placed in the care of other persons and/or facilities and that an attempt may or may not be made to place this animal for adoption. I also attest that to the best of my knowledge, the aforementioned animal has not bitten anyone at any point in their life.

Should the animal not be adoptable, or a suitable home not found, I understand the animal may be humanely euthanized. I further understand that after I release the animal to the custody of the LWHA, I will have no other contact with the animal in the future. I also agree to turn over all medical records I have for this animal to Long Way Home Adoptables including, but not limited to, vaccination records, surgical procedures, all provider notes, etc.

I agree

Send me a copy of my responses.

Submit

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