First name: Last name: Email address: Address 1: Address 2: City: State: Zip code: Home Phone: Work Phone: Employer: Do You? Rent Own Landlord's Name: Landlord's Phone: Do you have any children in your household?
If so, how many and what ages? Will the animal be kept on
the property? Yes No If yes, describe the area and shelter
to be provided (acreage, sheds, barn, etc.): Number of acres: Type of fencing: If no, provide the address and a description
of the boarding/training facility: Manager/Trainer: Phone: Do you own a horse or any other livestock now? How many? Description: If you have previously owned horses or
livestock please explain what happened to them: What type of horse or livestock are you
interested in? Preferred age: Preferred height: Preferred level of training: Intended use of horse: Pleasure Companion Show Other Intended use of livestock: If interested in adopting an equine, please describe
your level of expertise in the following areas: Riding: Handling/Training: Working with young or unbroken horses: Who will be responsible for the general
care of the horse? Who will be responsible for training? How much do you anticipate spending yearly for feed? For medical care? For worming? For Farrier? Please tell us why you would like to adopt
a horse or livestock? If you move in the future, what will you
do with this animal? Who will care for this animal when you
go on vacation? If you own livestock now, who is your
Veterinarian? Veterinarian's phone: Farrier: Farrier's phone: If not, who will be your Veterinarian? Veterinarian's Phone.: Farrier's Phone: Who is your small animal Veterinarian? Have you ever been issued a warning/citation
or been convicted for cruelty to animals or any humane violation? If so, please explain: Please indicate when it woud be convenient
for us to conduct a property/barn check: Please provide three professional references:
Name/Address/Phone: 2nd Reference - Name/Address/Phone: 3rd Reference - Name/Address/Phone: I/We certify that all information contained herein
is true and correct. (To be signed in person) Date:
