| First Name: |
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| Last Name: |
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| Address Street : |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Daytime Phone: |
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| Cell Phone: |
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| Evening Phone: |
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| Email: |
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| Occupation: |
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| Combined Annual Income: |
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| Intended Use for Horse: |
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| Name of Horse Interested in Adopting: |
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| Riding/Training/Horse Care Experience: |
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| Will the horse have regular turnout?: |
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Will the horse be kept in a stall? Run-in shed or Other?:
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| Size of Pasture: |
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| Type of Fence: |
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| Size of Stall: |
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| Will you be working with a trainer?: |
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| If so, name and number of trainer: |
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| Farrier Phone Number: |
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| Equine Dentist Phone Number: |
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| Vet phone number: |
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| Name, Phone Number and Relationship of Reference #1: |
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| Name, Phone Number and Relationship of Reference #2: |
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| Name and number of barn manager (if applicable): |
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| Name and phone of next door neighbor: |
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| Have you ever bred or do you plan to breed in the future?: |
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| Please list all the horses you have owned the last 15 years and where are they now?: |
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Do you plan to train and re-sell your adopted horse?:
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| Have you ever sold a horse to a dealer?: |
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| Have you ever called a rendering or packing company to pick up any past horses?: |
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| Have you ever Sold, Traded or sent a horse to Auction? If yes, which?: |
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| If your horse were to become lame and only pasture sound, do you intend to keep the horse as a pet for the duration of his/her life?: |
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I promise that all of the information provided has been truthful |
