Pet Surrender Application

Please complete this form as thoroughly and accurately as possible.                                                                                                                                                 It will to help us determine if this pet is a suitable candidate for our program, and to help us decide which foster home could best meet the needs of this pet.

Completing this form does NOT guarantee a placement for your pet.

Owner Information

First Name     

Last Name     

Address       

City               (please note: applications will only be accepted from the Peoria IL area)

State          Illinois

Zip Code  

Phone     Additional phone number if needed 

Email Address   

Preferred method of contact 

Best time to call 

Pet Information

Is this a DOG 

       or a CAT  ?

Is this your pet?   

 From where did your animal originally come (breeder, shelter, "pet store", etc.)?   

You are obligated to first contact the breeder or shelter before we can help you. We will NOT consider your pet until this has been done.  

How long have you had this pet? 

What breed is this pet? Please attach a photo to an email : fpo_mail@fosterpetoutreach.org   

Color of animal:     

Weight of animal (guesses are fine!)

Age of animal:     

Name of animal. 

Sex of animal    Male             Female

Is this animal spayed/neutered?    Yes           

Is this animal housetrained?          Yes           

Does this animal get along with other:     Dogs          Cats          Children 

Tell us about behavior. Is this pet friendly, affectionate, snippy, frightened, etc.?

How does this pet react when left alone? (i.e. separation anxiety, destructive behavior, etc.) 

Is this pet afraid of anything in particular? (i.e. men, thunder, etc.) 

Describe any training this pet has ever had, or any tricks they know: 

Has this dog EVER bitten another animal or person?     No            

If yes, under what circumstances? Please describe completely.  

Please list any other shelter or rescue you have contacted              

What steps have you taken to rehome your pet? Please check all that apply.

    Spoken to the breeder/Pet store/Rescue group about returning. (This MUST be done!)

    Advertised locally in newspapers or flyers

    Spoken to other rescue groups

    Other (please explain)

Why does your pet need to be rehomed? Please explain in detail.

What can we do that might help you to keep the pet?

Pet's Medical Information

What is the name and number of the veterinarian?     

Please list any names (yours and the pets)  these records may be found under.     

Is it up to date on vaccines and preventative medication? Yes            No             Not Sure 

What was the date of the last vet visit? 

Please list any medications the animal is currently taking.

Please describe ANY known health problems completely.

Each animal brought to Foster Pet Outreach is given a complete health check, vaccines if needed, spayed/neutered, and microchipped, at a cost of about $250. In addition, they will need food, monthly heartworm and flea prevention as well as toys, leashes and bowls. As an owner relinquish, you will be required to pay a relinquish fee.

Are you willing and able to contribute financially toward care for this animal? Yes            No          

How long can this pet safely stay where it is?

Foster Pet Outreach is not able to help every animal presented to us. Occasionally, however, we will know of an individual looking for such an animal. We are happy to pass along information for you, with the understanding that such contact will be a Private matter between you and the other party, with no guarantees or warranties from Foster Pet Outreach. May we give out your name, phone number and email to an interested Private party?