Livestock Guardian Dog Registration Form

Livestock Guardian Dog Registration Form

Please complete this form to register a Livestock Guardian Dog in Douglas County, Kansas. A non-negotiable and non-refundable fee of $25.00 is required to submit your registration application. If you have questions about this form or need assistance, please email animalservices@lawrencehumane.org.
Livestock Guardian Dog Code (Douglas County, KS)
Please review the definition below of a Livestock Guardian Dog as defined in Chapter 2 of the Douglas County, KS code.

If your dog is maintained in unincorporated Douglas County, KS; your dog meets the definition of a Livestock Guardian Dog; and you wish to register your dog as such, complete the form below and pay a $25 regsitration fee to the Lawrence Humane Society.

Per 2-101 (o) of the of the Douglas County, KS Code, a Livestock Guardian Dog means a dog used to live with and guard livestock, other than itself, from predators. The following characteristics and conditions shall apply to this definition:
1. Has free range to roam within a property where a livestock herd is also present; and
2. Fresh water and food is made available daily, along with adequate shelter available at all times;
3. General welfare is monitored by a person on a daily basis;
4. The dog must be microchipped and registered with the Animal Shelter pursuant to Section 2-213.
I have read and reviewed the definition of Livestock Guardian Dogs as defined in Chapter 2 of the Douglas County, KS code.*

I agree
Today's Date*

MonthDayYear
Date
Name*

First NameLast Name
Signature*

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Livestock Guardian Dog Registration Form

Please complete this form to register a Livestock Guardian Dog in Douglas County, Kansas. A non-negotiable and non-refundable fee of $25.00 is required to submit your registration application. If you have questions about this form or need assistance, please email animalservices@lawrencehumane.org.

Animal Owner Information
Livestock Guardian Dog Owner Information

The following information provided will serve as the legal record of the designated owner/guardian (‘Animal Owner’) who holds primary responsibility for the registered livestock guardian dog. Designated owner/guardians must be at least 18 years of age. Please complete all required fields.
Animal Owner's Full Name*

First NameLast Name
Date of Birth

MonthDayYear
Animal owner must be at least 18 years of age
Email Address*
example@example.com
Primary Phone Number*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Property Owner Information
Property Owner Information

The information provided below will serve as the legal record of the designated owner (‘Property Owner’) who holds primary ownership and responsibility for the property where the registered livestock guardian dog resides. Please complete all required fields.
Property Owner's Full Name

First NameLast Name
Phone Number*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Email Address*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the address of the property where the Livestock Guardian dog resides different than the Property Owner's mailing address?*

YesNo
Property Address (where the Livestock Guardian Dog resides)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Animal Information
Livestock Guardian Dog Information

The information provided will serve as the legal record of the registered livestock guardian dog and will be maintained for identification and verification purposes. Please complete all required fields.
Dog's Name *
Breed*
If a mixed breed, list all known breeds.
Age*
(EX: 4y = four years, 18m = eighteen months, etc.)
Gender of Dog*
Coat Color(s)*
Coat Length*
Microchip Number*
Enter the unique 9–15 digit identification number from your dog’s microchip.
Brand of Microchip
Enter the brand or manufacturer of your dog’s microchip (e.g., HomeAgain, AKC Reunite, 24Petwatch)
Microchip Company Provider/Registry*
This is the company where the dog’s microchip is registered. (e.g., HomeAgain, AKC Reunite, 24Petwatch, PetLink, BuddyID, Fi Nano, Save This Life).
Other Identifying Features (if applicable)
(e.g., coat pattern, distinctive markings or traits, tattoo, scar, etc.)
Animal Identification Photo #1*

Please include a clear, in-focus photo of the dog's head as well as a photo of the dog's entire body.
Cancelof
Animal Identification Photo #2*

Please include a clear, in-focus photo of the dog's head as well as a photo of the dog's entire body.
Cancelof
Proof of Current Rabies Vaccine

Please attach a record of your pet's most recent rabies vaccine. Documentation should include who administered the vaccine and when the vaccine expires.
Cancelof

Agreement and Acknowledgment
Livestock Guardian Dog Registration Agreement and Acknowledgment

Please review the following terms carefully. Your acknowledgment and agreement are required to complete the registration of your livestock guardian dog.
I hereby affirm that I am (select all that apply):*

The lawful owner of the dog described hereThe owner of the property where the dog described here is kept
I hereby agree to comply with all keeping requirements outlined in Chapter 2 of the Douglas County Code, specifically Sec. 2-101(o) and Sec. 2-213.*

I agree.
I hereby attest that the information provided is true, correct, and complete to the best of my knowledge and belief. I further acknowledge that any false, misleading, or omitted information may render this Livestock Guardian Dog Registration null and void, and may subject me to any remedies or actions deemed appropriate by the Animal Services Division of the Lawrence Humane Society.*

I agree.
I acknowledge that ownership of a registered livestock guardian dog does not exempt me from compliance with any applicable animal codes, laws, or regulations. I agree to comply with all such requirements at all times as a condition of this registration.*

I agree.
Signature

By signing below, you acknowledge and agree to the terms outlined in this registration.
Today's Date

MonthDayYear
Date
Name*

First NameLast Name
Signature*

Clear

Payment

Required Payment for Registration Fee*

Livestock Guardian Dog Registration Fee Product Image

Livestock Guardian Dog Registration FeeIf your dog is maintained in unincorporated Douglas County, KS; your dog meets the definition of a Livestock Guardian Dog; and you wish to register your dog as such, complete the form below and pay a non-negotiable $25.00 registration fee to the Lawrence Humane Society.

$25.00

Total

$0.00

Credit Card

Should be Empty:

Livestock Guardian Dog Registration Form

Livestock Guardian Dog Code (Douglas County, KS)

Livestock Guardian Dog Registration Form

Livestock Guardian Dog Owner Information

Property Owner Information

Livestock Guardian Dog Information

Livestock Guardian Dog Registration Agreement and Acknowledgment

Signature

Credit Card