Horse Intake Form

Horse Intake Application
Do you have a horse you would like to donate to our riding program?*

YesNo
Do you have a horse you would like to surrender to the Rescue?*

YesNo
Name of Horse*
Nickname
Breed*
Color*
Markings*
Age*
Sex*
Blanket Size
Blanket Included
Date feet done last*

MonthDayYear
Date
Shoes*
If your horse has any special needs we need to consider please list them here. *
Current on Vaccinations?*

YesNoUnknown
Select all Vaccinations that are current.*

Basic 5 WayTetnusInfluenzaWest NileStranglesOther
Current Health Certificate?*

YesNo
Health Certificate Date*

MonthDayYear
Date
Current Coggins?*

YesNo
Coggins Date?

MonthDayYear
Date
Current Brand Inspection?*

YesNo
Date of Brand Inspection

MonthDayYear
Date
State of Brand Inspection
Owner Name*
Address*
Phone*
Email*
example@example.com
Pick up Address and any additional Instructions*
Date to Pick up*

MonthDayYear
Date
The above stated horse is being donated to Rafter M Ranch Riding and Rescue Corporation. This document is to acknowledge that the above stated owner so conveys all ownership to Rafter M Ranch Riding and Rescue Corporation effective
Date*

MonthDayYear
Date
Donating Owner*
Signature of Owner*

Clear
Signature of Staff upon Intake

Clear
Date

MonthDayYear
Date
Rafter M Ranch Riding and Rescue Corporation 15872 E Hwy 44, Caputa, SD, 57725
Should be Empty:

Horse Intake Application