Pet Surrender Application

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

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

Owner/Rescuer 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 

Pet Information

Is this a DOG 

       or a CAT  ?

Is this your pet or one you found?   

Where did you find this animal, or if you own it, where did it come from (breeder, shelter, "pet store", etc.)?

If this was a stray, did it have a collar, tags or tattoo? Please describe. 

How long have you had this pet? 

What breed is this pet, or your best guess?  If you are guessing, please give us a description to support your thoughts- long/short hair, weight guess, etc.

Color of animal: 

Age of animal, or best guess: 

Name of animal (if known). 

Sex of animal    Male             Female

Is this animal spayed/neutered?    Yes           

Is this animal housetrained?          Yes           

Is this animal crated trained?        Yes           

If this is a cat, is it declawed?        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.  

If this animal is a stray, what steps have you taken to find the owner? Please check all that apply.

    Posted flyers where the animal was found.

    Posted an ad in the local papers

    Notified the local animal shelters

    Had the animal scanned for microchip

    Checked with local vet clinics

    Other  (Please explain) 

If this animal is your animal, what steps have you taken to rehome him/her? Please check all that apply.

    Spoken to the breeder/Pet store/Rescue group about returning

    Advertised locally

    Advertised on the internet (such as www.petfinder.com)

    Spoken to other rescue groups

    Other (please explain)

If this is your pet, why does it need to be rehomed? Please explain in detail.

If this is your pet, what steps have you taken to resolve the problem without rehoming? What can we do that might help you to keep the pet?

Pet's Medical Information

If this is a stray, have you taken it to the vet?     Yes            No 

What, if any, treatments were given?

 What is the name and number of the veterinarian? 

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

If you own this animal, 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.

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?