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

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

NOTE: DO NOT USE THIS FORM FOR DOGS OR CATS.  Click here to fill out the Dog Surrender form. Click here to fill out the Cat Surrender form.

Name *
Address *
Phone (Home or Cell) *
Phone (Home or Cell)
Gender *
Please give best estimate if unsure.
Is it spayed or neutered? *
If there were health issues, please describe them.
Please be specific.
Can you foster the pet while it's up for adoption? *
If from a rescue, have you contacted the rescue to inquire about surrendering the animal?
Most rescues have policies in place that require the adopted pet be surrendered to them.
I affirm the above questions were answered truthfully and that I am the legal owner of this pet. *
I agree that I will email a photo of the animal within 24 hours to with the subject of "(Pet's name) - (Your name) - Surrender" *
Please help us care for your pet while we work to rehome *
Suggested donation for a small animal surrender is $10. However, any amount is helpful.