Horse Intake Form

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

Yes No
Do you have a horse you would like to surrender to the Rescue? *

Yes No
Name of Horse *
Nickname
Breed *
Color *
Markings *
Age *
Sex *
Blanket Size
Blanket Included
Date feet done last *

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

Yes No Unknown
Select all Vaccinations that are current. *

Basic 5 Way Tetnus Influenza West Nile Strangles Other
Current Health Certificate? *

Yes No
Health Certificate Date *

Month Day Year
Date
Current Coggins? *

Yes No
Coggins Date?

Month Day Year
Date
Current Brand Inspection? *

Yes No
Date of Brand Inspection

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

Month Day Year
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 *

Month Day Year
Date
Donating Owner *
Signature of Owner *

Clear
Signature of Staff upon Intake

Clear
Date

Month Day Year
Date
Rafter M Ranch Riding and Rescue Corporation 15872 E Hwy 44, Caputa, SD, 57725
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Horse Intake Application