Please fill out the following form if you are interested in surrendering your dog to Heartland Small Animal Rescue.  Filling out this form does not guarantee we will take in the dog.  After filling out this form, you MUST email a photo of the dog within 24 hours to heartlandsmallanimalrescue@gmail.com with the subject of "(Dog's name) - (Your name) - Surrender".

Please answer these questions truthfully and to the best of your knowledge.  Your dog's vetting status, health, or behavioral issues are not automatically going to exempt them from being accepted into our adoption program.

Name *
Name
Address *
Address
Phone (Home or Cell) *
Phone (Home or Cell)
Gender *
Please give best estimate if unsure.
Size *
Is it spayed or neutered? *
Is it up to date on its rabies vaccine? *
When was the date of its last rabies vaccine?
When was the date of its last rabies vaccine?
Is it up to date on its distemper vaccine? *
When was the date of its last distemper vaccine?
When was the date of its last distemper vaccine?
Has it been tested for heartworms? *
Is it on monthly heartworm prevention? *
When was the date of its last heartworm prevention dose given?
When was the date of its last heartworm prevention dose given?
Please be specific.
Does the dog get along with other dogs? *
Does the dog get along with cats? *
Does the dog get along with children? *
Can you foster the dog while it's up for adoption? *
Is the dog housebroken? *
If you adopted your dog from a rescue, have you contacted the rescue first to inquire about surrendering the dog?
Most rescues have policies in place that require the adopted pet be returned to them.
I affirm the above questions were answered truthfully and that I am the legal owner of this dog. *
I agree that I will email a photo of the dog within 24 hours to heartlandsmallanimalrescue@gmail.com with the subject of "(Dog's name) - (Your name) - Surrender" *