Pet Surrender Form

Thank you for entrusting the life of your pet to Foster Pet Outreach. A volunteer will follow up with you as soon as possible.

Please understand that placement of your pet will be based on an assessment of your pet’s compatibility with our program and current foster home availability.

(Our intake of animals is limited by the number of current foster homes available and foster animals currently being housed therein.)

09/20/22 UPDATE: Unfortunately, we are not able to take in any more cats at this time. We will update this page again when we are able to do so.

CONTACT INFORMATION
Name:*
Age:*
Email:*
Street Address:*
City:*
State:*
Zip Code:*
Home Phone:*
PET'S HEALTH AND GENERAL INFORMATION
Pet's Name:*
What was the pet's name at the time of adoption?*
Pet's Breed:*
Pet Type:*
Pet's Age*
Pet's Weight:*

lbs
Spayed/Neutered:*
Date of last Rabies shot:
MM slash DD slash YYYY
Date of most recent shots and type:
MM slash DD slash YYYY
Date of last Heartworm/FELV test:
MM slash DD slash YYYY
Is your pet currently on heartworm prevention?*
If so, what brand of heartworm prevention is your pet currently using?
Please describe the pet's medical history:
Does the pet have a current vet?*
VET INFORMATION
Vet's Name*
Vet's Phone Number:*
How does your pet respond in public settings?(Happy, Fearful?...)
Does your pet suffer from separation anxiety?
If so, is it currently on medication (Type and dose)?
How does your pet respond to your vet?(Happy, Fearful?...)
Pet Food Brand:
How often is your pet fed?:
How much do you feed this pet?:
Has the pet received any training/obedience during Its time with you?:*
Has the pet lived primarily inside or outside?:*
Is the pet house trained?:*
Has the pet ever bitten anyone?:*
Please explain the circumstances of the bite incident:*
How does the pet react to children?:*
Why are you relinquishing your pet?:*
How long have you owned this pet?:*
How long can this pet safely stay where it is?:*
Please tell us what exposure your pet has had to cats, dogs or kids (ages) and how they reacted.*
Did you purchase this pet from a breeder?:*
BREEDER INFORMATION
Please provide the breeder's name, address, phone number, and email:*
Have you contacted the breeder?:*
What response did you get?:*
Where did you get this pet?:*
Upload a photo(s) of your animal here. We require photos because they will greatly increase the chances of finding a loving home for your pet. If you cannot upload photos here, please email the photos with a description to: fpo_mail@fosterpetoutreach.org (We cannot accept your surrender form without a photo)
Accepted file types: jpg, gif, png, bmp, tif, Max. file size: 10 MB.
Files must be less than 10 MB. Allowed file types: gif jpg png bmp tif.
- By signing this document, I attest that I am sole and lawful owner of the aforementioned animal.
- I affirm that, by signing this form, I permanently waive any and all rights whatsoever that I have to the aforementioned animal. I understand that the animal becomes the property of Foster Pet Outreach immediately upon my signature to this document. I attest that there have been no promises made to me with regard to the animal, nor force used against me to relinquish this animal. I am doing this act freely and voluntarily.
- I agree to pay a one-time, non-refundable fee of $25 to Foster Pet Outreach in connection with this service. I certify that Foster Pet Outreach does not owe me any form of payment in relation to acquiring this animal.
- I understand that the relinquishment of this animal and the reason for the same is not private information, and I permit Foster Pet Outreach to report the same to animal rescues, the state, or any other individual that they deem appropriate. This is done to facilitate the adoption of the animal by responsible owners.
- I understand that should I desire the animal back after relinquishment, I will be required to reapply for the animal, pay the adoption fee, and waive the surrender fee. Further, I understand that I may be denied the return of the animal, or permitted only conditional return of the animal.
- I understand that I am responsible to pay all outstanding bills for veterinary care, food and supplies that I was extended with regard to the animal despite the animal being surrendered to Foster Pet Outreach.
- I understand that, should Foster Pet Outreach have to defend against litigation or any case in relation to this surrender, I agree to pay all court costs and Foster Pet Outreach’s attorney’s fees accrued in association therewith. I testify that the above information is complete and true to the best of my knowledge, and that I have never been charged with cruelty to animals.
- By signing this, I give Foster Pet Outreach permission to review all veterinarian records in regards to this animal.
Digital Signature*
Can we share your information with a private party?
- Yes
- No
CAPTCHA

MISSION STATEMENT
The mission of Foster Pet Outreach is to help at-risk animals with a focus on dogs and cats. Through an all volunteer base, we determine the individual needs of vulnerable dogs and cats in our foster home program until they find a forever home. All donations stay local and go directly to foster pet care.

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Contact Information

Foster Pet Outreach
10206 W. DuBois Rd PO Box 4
Edwards, IL 61528
(309) 682-1122