Please enable JavaScript in your browser to complete this form.Contact Name *FirstLastContact Phone Number *Contact Email Address *Where is the dog currently located? *Please note that Heartland Animal Shelter is located in Northbrook, IL.Dog's Name *Dog's Breed *Dog's Age *Gender *MaleFemaleSpayed or Neutered? *YesNoBreed Size *SmallMediumLargeApproximate Weight *Where did you originally adopt or purchase your dog from? *Date of last canine distemper vaccine? *Date of last rabies vaccine? *Date of last heartworm test? *Date of last heartworm preventative administration? *Date of last flea/tick preventative administration? *Veterinarian Name/Clinic Information *Please note that a copy of your dog's medical records is required for consideration.Why do you wish to surrender your dog? *Does your dog have any health issues? *Is your dog on any medications? *What food does your dog eat? *Who is in your household with the dog? *AdultsTeenagersChildren Under 13Is your dog house trained? *YesNoAfter how many hours will your dog have an accident if left alone? *Is your dog paper trained? *YesNoHow many hours is your dog left alone each day? *Where is your dog kept when alone? *CrateOutsideIn a RoomLoose in HouseOtherMy dog is good with (check all that apply) *KidsDogsCatsStrangersHow does your dog behave around other dogs? *PlaysIgnoresGrowlsSnaps/BitesDon't KnowCheck all that apply.How does your dog behave around cats? *PlaysIgnoresGrowlsSnaps/BitesDon't KnowCheck all that apply.How does your dog behave around strangers? *FriendlyToleratesIgnoresGrowlsBarksSnaps/BitesCheck all that apply.How does your dog behave around children? *FriendlyToleratesIgnoresGrowlsBarksSnaps/BitesCheck all that apply.Does your dog know any commands? *SitDownStayShakeCheck all that apply.Has your dog ever bitten anyone? *YesNoIs your dog good on a leash? *YesNoHow does your dog behave on a leash? *PullsExcitedWalks CalmlyRefuses to WalkNot Leash TrainedLunges or Barks at DogsLunges or Barks at CatsLunges or Barks at StrangersCheck all that apply.Please include a brief overview of the situation, including any behavioral and/or medical issues so we can best assist you and your dog's needs. *Please understand that your inquiry will go unanswered without all of the above information provided.Photo of Dog Click or drag a file to this area to upload. Submit
When you adopt from a no-kill shelter, you save two lives. The animal you adopt and the one that replaces him.
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If you’re not ready to adopt or volunteer, consider making a financial contribution to help the shelter continue its life-saving mission.