Check Me Out Form

Step 1 of 4

This field is for validation purposes and should be left unchanged.

Do you have a PID Number? (If unsure, click 'no')(Required)

Yes

What is your PID Number?(Required)

I understand that this form is applicable to dogs at the LHS SUSAN M. MALCOMB HUMANE CAMPUS (1600 Old Frankfort Pike) only.(Required)

Yes

Your Name(Required)

First Last

Your Address(Required)

Street Address Address Line 2 City State ZIP Code

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Date of Birth(Required)

ID Type & Number(Required)

Do you have any animals currently in your home?(Required)

Yes

If yes, list the animals currently in the home.(Required)

Please read and abide by the following Check Me Our rules and check each box after reading.(Required)

I understand all LHS rules and Fayette County animal ordinances must be followed at all times, which include but are not limited to leash laws, animal waste disposal laws, and barking dog/noise laws.

I agree to follow the Do’s & Don’ts list the entire time the dog is in my care.

I agree to have the dog back no later than 5 pm on the same day I checked the dog out. I understand that failing to bring the dog back by 5 pm will result in a report filed with the police.

I will follow any extreme temperature protocols that LHS has in effect today.

I assume all responsibility for the animals and its actions and will assume all liability.

Lexington Humane Society

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