✕
Menu
HOME
ALL ADOPTABLE PETS
PUPPIES
ADULT DOGS
DONATE
DONATE TO HELP 13 NEGLECTED DOGS
DONATE TO VET CARE FUND
DONATE FOR MATILDA
SHOP
APPLICATIONS
Adoption Application
Foster Application
Volunteer
Facebook
Owner Surrender/Citizen Turn In
Surrender Date
*
MM slash DD slash YYYY
Acquisition (pick one)
*
Stray
Owner Surrender
Citizen Turn In
Species
Cat
Dog
Single animal or Mom & litter of 2 or more?
*
Single
Mom & Litter
Litter Only
Special Circumstances for Mom & Litter
Prior agreement has been made between Lucky Chance Rescue and owner to transfer temporary possession of mom and ownership of the litter of puppies to Lucky Chance Rescue. Once the puppies are weaned at 8 weeks old, Lucky Chance Rescue will cover the costs to spay mom at one of our approved veterinarians and return to owner after surgery is completed. The puppies will remain with Lucky Chance Rescue. This agreement must be made prior to surrendering to Lucky Chance Rescue. If no agreement has been made, Lucky Chance Rescue will take permanent ownership of mom upon surrender.
Yes, Lucky Chance will Spay and Return Mom To Owner
No, Owner relinquishes all rights of ownership to Lucky Chance Rescue
Animal Name
Sex
Male
Female
Breed
Age (DOB)
If Litter, add additional animals below
Name
Sex
Breed
Age (DOB)
Description
Click the + sign to add as many as you need
Add litter here. Click + sign to include information for each animal
Species
ID#
Name
Sex
Breed
DOB/Age
Description (size, color, markings, distinguishing characteristics):
Animal Details
How did you obtain the animal(s)? Shelter / Rescue / Pet Store / Stray, etc. Does he/she have health or behavioral issues? Good with dogs, cats, kids? Housebroken, (litter box trained, if cat) Please give as much detail as possible
Upload Photo(s) of Animal
Drop files here or
Select files
Max. file size: 1 GB, Max. files: 10.
Owner/Citizen Name
*
Phone
*
Address
*
Street Address
City
State
ZIP / Postal Code
Driver's License or Vehicle License #
*
Upload Photo Of Driver's License
Max. file size: 1 GB.
To the best of your knowledge has this animal bitten anyone in the previous 10 days?
Yes
No
Does this animal have some form of ID? If yes, please describe below (collar, microchip, tattoo?)
Yes
No
Type of ID
Address or location where animal was found (if not owner surrender)
Vaccination Information
If you have vet records, please upload them here, otherwise skip
Max. file size: 1 GB.
Signature Of Person Surrendering
*
CAPTCHA
Lucky Chance Intake Info
To Be Completed by Lucky Chance Admin
Person Completing Intake
Intake Date
*
MM slash DD slash YYYY
LCR Animal Name
Rescue ID
Intake For Litter
Rescue ID#
LCR Name
Sex
DOB/Age
Description (size, color, markings, distinguishing characteristics):
Was Transport Involved?
Yes
No
Transporter / Volunteer Name
Please list all transporters below, click the + symbol to add more.
Full Name
Phone Number
Vehicle License or Drivers License Number
Owner /Citizen Transport Information
Signature – Lucky Chance Rescue Representative
Name
This field is for validation purposes and should be left unchanged.
↑