Polk County Humane Society Request to Surrender Form

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Personal Information

Additional Information

Description of Pet(s)

Pet's Health Information

Pet's Behavior Assessment

Foster-in-Place Program

Polk County Humane Society offers a Foster in Place program. With the Foster in Place program, you surrender the pet and then foster it until PCHS either has room or the pet is adopted. In the meantime, you would bring the animal in for vaccinations, preventatives and a neuter or spay surgery, if needed. PCHS provides food and supplies for fosters. The pet would be posted for adoption and you would need to be willing to meet potential adopters at the Humane Society. It is work on your part to foster in place, but if you are interested in the program, please indicate that below. The surrender fee of $25 or $50 still applies and there is additional paperwork for the Foster in Place program.

Signature

I certify that the information included in this surrender request form is accurate and true. I understand that if I fail to tell the truth about the animal(s) that I wish to surrender, I  could  endanger the safety of a staff person or another pet at Polk County Humane Society.


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