If you do not receive a response to your submitted application within 2 business days, please contact us at 574-400-5633 or

Enter the name of the specific pet you would like to adopt. If you are interested in several dogs, enter all names.
I am looking to *
Applicant Information
Name *
Address *
Where do you live? *
Do you own or rent your home? *
Do you have homeowner's insurance? *
Home Phone *
Home Phone
Cell Phone
Cell Phone
Are you 18+ years old?
Who, besides you, resides in your home (name, age, relationship, and whether it is part or full-time)
Please list your current animals (name, species, sex, breed, and age).
Are Current Pets Spayed/Neutered?
Please list all your animals you have owned in the last 5 years, not including current animals) (name, species, breed, sex, age and where they are now)
Are your current dogs on Heartworm preventative?
Veterinarian used for your pet(s) (if you do not currently have pets, please list the vet used for your previous pets). List name of clinic, phone number, address, name(s) of pets treated here, and name the account is under. Some vets require you to release your records to Heartland; please call your vet and advise them a representative from Heartland will be calling to check on the vetting status of your pets.
Vet's Phone Number
Vet's Phone Number
Have you ever turned a pet into a shelter? *
Approximate size, fenced or not. Having a fenced in yard is not a requirement.
Crate, specific room, free roam of the house, etc.
Will this pet be primarily an indoor or outdoor dog? *
How long will your pet be left alone daily? *
Tie out, run, fenced yard, kennel, unsupervised, etc.
If you move, are you willing to take your pet with you? *
Do you agree to allow a Heartland representative to perform a home visit before and after adoption? *
A home visit is not required for all adoptions, but may be requested at any point after adoption.
How did you hear about this pet? *
This can be a friend, family member, employer or member of the clergy. Be sure to include name, address and phone number.