Surrender Application

Your Name*







Dog's Name*

 Male Female

 Yellow Chocolate Black


Is the Dog Spayed/Neutered?*
 Yes No

Age of Dog*

Is this Dog*
 Adopted from HLR Your Dog Stray

Describe the Dog*
 Housebroken Crate trained Obedience trained Food aggressive Good with dogs Good with cats Good with children I don't know

Are you able to leave him/her unattended in the house for long periods of time without him/her damaging anything?*
 Yes No I don't know

Will your dog jump a fence?*
 Yes No I don't know

Describe your dog's general temperament*

Has your dog ever snarled or snapped?* Please explain.

Has your dog ever shown fear (strangers, thunderstorms, etc)?* Please explain.

Has your dog ever bitten a person or other animals?* Please explain.

Why are you unable to keep your dog?* Please explain.

We have very few foster homes. Are you able to foster your dog until we find a home for him/her?*
 Yes No

Heartland Lab Rescue survives on the help of volunteers and resources from our supporters. Are you able to volunteer or offer resources to help in the mission?*
 Yes No

Surrender Agreement

I agree that if Heartland Lab Rescue takes my dog into the HLR program that it will at that point be under the care of HLR to find it a home and I can not give my surrendered dog to anyone. I will direct anyone interested, including family and friends, to complete an adoption application on the Heartland Lab Rescue website.*
 I Agree

Spam Security


Please enter the above letter/number combination

Thank you, again, for your interest in Heartland Lab Rescue.  We run solely on volunteers that have full-time jobs and commitments as well.  It may be a day or two before we are able to contact you.  The application process typically takes 4-6 days from when you submit the application.


Important Information

At this time we are having to limit our intake of dogs that can be fostered until adopted.

We will need a picture of your dog to process your application.  Please e-mail pictures to with you dog’s name and your name in the subject line.  We will not be able to process your application without a picture.

In most circumstances we require that the dog be current on all vaccinations and spayed or neutered.