Owner Surrender Request Form

What species is the animal you would like to surrender? *

Dog
Cat

Pet Name *

Was this pet adopted from A.R.F.-Animal Rescue Foundation in Illinois? *

Yes
No

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Mobile Phone *

Alternative Phone

Animal Sex: *

Male
Female

Breed *

Mixed
Purebred

Breed information *

Describe the known animal breed information. If not known, list "unknown."

Coat/Fur Type *

Approximate Age *

Vet Information

Vet Name *

Vet Address *

Address Line 1

Address Line 2

City

State

Zip Code

Vet Phone *

Detailed Animal Information

Is the animal current on vaccinations? *

Yes
No
I don't know

Is the animal spayed/neutered? *

Yes
No
I don't know

Is the animal microchipped? *

Yes
No
I don't know

Is the animal on any medication? *

Yes
No

Is the animal good with dogs? *

Yes
No
I don't know

Is the animal good with cats? *

Yes
No
I don't know

Is the animal good with kids (under 6)? *

Yes
No
I don't know

What amount of exercise does the animal require on a daily basis? And receive? *

What does the animal do during the day while you are at work? *

Where is the animal kept at night while you are asleep? *

Where is the animal kept when you are home? *

Does the animal exhibit any problem or destructive behaviors? *

Additional Information

Why are you giving up this animal? *

Is there any other information we should know?

Please list any other information about the animal that would be useful for our foster homes or potential new adoptive families to know. Please list both good and bad things that we should know.

Has the animal bitten or scratched a *human* within the past 10 days? *

Yes
No

Has the animal bitten or scratched *another animal* within the past 10 days? *

Yes
No

Agreement and Signature

By submitting this request form, I certify the information provided is complete and correct to the best of my knowledge and I give my permission to A.R.F.-Animal Rescue Foundation for all information to be verified. I give permission for my name, address, phone number, and email information to be collected and for A.R.F. to communicate with me via email and phone. We only use this information to communicate with you regarding our organization and do not share or sell your data. I agree that if any information in this request is deemed to be false or misleading after the time of surrender, A.R.F.-Animal Rescue Foundation has the right to, and may, deny the request for surrender. I agree to provide additional information in a timely manner, if required. I understand A.R.F.-Animal Rescue Foundation has the right to deny any request and that my request has not been approved until I receive written verification from A.R.F. that my request has been approved.

By signing below, I hereby certify that I am the rightful owner of the animal(s) who is/are the subject of this Animal Surrender Request Form, hereinafter referred to as "the animal."

I hereby surrender any and all property rights to the animal. I certify that no other person has a right of property to the animal. I understand that once I relinquish the animal, all ownership rights are fully transferred to A.R.F. and the animal will not be returned. I further certify that I have read, understand, and agree to the terms of this Animal Surrender Request Form.

Name *

Vet Information

Detailed Animal Information

Additional Information

Agreement and Signature

Upcoming Events

Recent News and Events

Rex