Survey - Lost and Found Form - Humane Rescue Alliance

1.

Please provide your contact information below:


*	First Name: Required
	Middle Name:
*	Last Name: Required
	Email:
*	Street 1: Required
	Street 2:
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
	Country:
*	Phone Number: Required
	Yes, I would like to receive e-mail from Humane Rescue Alliance
	Email Format:

*2.

Question - Required - Animal Name

*3.

Question - Required - Species

Dog

Cat

Other

*4.

Question - Required - Age

*5.

Question - Required - Primary Breed

6.

Question - Not Required - Secondary Breed

*7.

Question - Required - Gender

Male

Female

Unknown

*8.

Question - Required - Spayed/ Neutered

Yes

No

Unknown

*9.

Question - Required - Size

Small

Medium

Large

Extra Large

10.

Question - Not Required - Weight (lbs.)

*11.

Question - Required - Condition

Normal

Fearful

Injured

Illness

Geriatric

*12.

Question - Required - Primary Color

Black

Brown

Blond

Gray

White

Tan

Orange

Red

13.

Question - Not Required - Secondary Color

Black

Brown

Blond

Gray

White

Tan

Orange

Red

14.

Question - Not Required - Color Pattern (Calico, Brindle, Tabby, Spotted)

*15.

Question - Required - Has the animal ever bitten anyone?

Yes

No

Unknown

16.

Question - Not Required - Microchip #

17.

Question - Not Required - Pet ID #

18.

Question - Not Required - Pet ID Type

Dog License

Rabies Tag

Other Tag

19.

Question - Not Required - Collar Type

None

Bandana

Canvas

Flea

Harness

Leather

Nylon

Rope

Choke

Spiked

Studded

Other

20.

Question - Not Required - Collar Color

Black

Blue

Green

Red

Pink

Brown

Orange

Purple

Tan

White

Yellow

Silver

Multi

Other

*21.

Question - Required - Lost or Found

Lost

Found

*22.

Question - Required - Date Lost/Found (Ex: January 01, 2013)

*23.

Question - Required - Location/Address Where Lost or Found (must include exact address including city, state, zip code, or specific cross streets):

*24.

Question - Required - Jurisdiction

NE

NW

SE

SW

Montgomery County

PG County

Other

25.

Question - Not Required - Additional information, such as distinguishing marks, behavior notes, or condition of the animal.

VERY IMPORTANT:
Upon submitting your form, call 202-723-5730 to confirm receipt, then please send a photo of the pet to frontdesk@humanerescuealliance.org.