Surrender Form


Note: At this time we are having to limit our intake of dogs that can be fostered until adopted. In some cases, we request a donation of owners giving up their dog.

We check all dogs for temperament, current health status and whether it is a Labrador retriever. We will also need a picture of your dog to process your application; pictures can be sent to surrender@heartlandlabrescue.com.

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

PERSONAL INFORMATION:

Full name of Applicant:
Spouse:
Address:
City:
State:
Zip:
Email:

*note, we communicate primarily through email.
Home Phone:
Work Phone:

DOG'S INFORMATION:

Dogs Name:
AKC Number (if applicable):
Sex Male Female
Color
Weight:
Spayed/Neutered Yes No
Age of Dog
Date Available / /
If this dog is a stray, how long have you had the dog?
Have you tried to contact the dog's breeder? Yes, we contacted the breeder.
What did they say?

No, we did not/cannot contact the breeder
If no, why not?

The information below will help us find the best possible home for your dog.
Does your dog like:

Swim
 Cats
Other Dogs
Children
Baths
Car Rides
Being Brushed
Strangers
Please elaborate any other Likes/Dislikes
Is your dog Housebroken
Crate trained
Obedience trained
 Food Aggressive (i.e. dog growls if you get near food/bones/toys)
Does your dog Chew
 Bark
Jump on people
Dig
Come when called
 Walk on lead
Does your dog know Sit
Stay
 Heel
 Down on command
 Fetch
Can you leave him/her unattended in the house for long periods of time without him/her damaging anything? Yes No Don't know
Any other special training or tricks?
Will your dog jump a fence? Yes No
How high is the fence the dog is kept in now?
Do you have a local Veterinarian? Yes No
If yes, provide info.: Name
Address
Phone
Dog's feeding instructions
What brand of dog food does your dog eat?
How often do you take your dog outside?
How does the dog let you know it's time to go outside?
What kind of exercise does your dog get?
Where is the dog during the day?
Where is the dog at night (where does the dog sleep)?
Describe the dog's general temperament
Has this dog ever snarled or snapped?
Has this dog ever shown fear (of strangers, thunderstorms, etc.)?
Has this dog ever bitten a person or other animals?
Why are you unable to keep this dog?
Additional Comments
We have very few foster homes. Can you foster this dog until we find a home for him/her? Yes No

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 fill out an adoption application on the Heartland Lab Rescue website.		 I Agree I Do Not Agree

We will need a picture of your dog to process the application; please e-mail pictures to surrender@heartlandlabrescue.com with your dog's name and your name in the subject line. We will not be able to process your application without a picture.

Heartland Lab Rescue survives on the help of volunteers and resources from our supporters. Would you be able to volunteer or offer resources to help in the mission?

Thank you again for your interest in Heartland Lab Rescue. We are 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.