HWH Rescue Equine Adoption Application

LEGAL FULL NAME *

First NameLast Name

DATE OF BIRTH (DD-MM-YYYY): Numeric
HOME PHONE: Home
CELLPHONE: Cell
WORK PHONE: Work

ADDRESS WHERE THE EQUINE WILL BE LOCATED: *

Street Address

Street Address Line 2

CityState

Zip Code

Mailing Address (if different from above):

Street Address

Street Address Line 2

CityState

Zip Code

EMAIL*

example@example.com

Employer

Driver's License Information (optional)
STATE: State NUMBER: Number

How did you hear about Horses Without Humans Rescue Organization?*

Why do you want to adopt an equine?*

Have you ever been issued a citation, or a warning, or been convicted of animal cruelty?*

YESNO

If YES, please explain:

EXPERIENCE: What is your level of riding/equine experience?*

NOVICE: No experience but keen to learn and work with horsesBEGINNER: Some experience handling horses. Comfortable at a walk and trot, with some experience at faster gaitsINTERMEDIATE: Can handle and ride horses that test a handler or rider. Comfortable at all gaitsADVANCED: Comfortable handling and riding difficult horses in various situations and environmentsEXPERT: Have previous experience training and/or experience handling green horses

Have you ever owned an equine?*

YESNO

If YES, how many?   number
Please explain their uses (trail riding, dressage, companion, etc)   style type
How many equines do you currently own?   number
What style of riding or driving do you practice?     style type

FACILITY OR BOARDING INFORMATION

Where do you plan to keep your horse?**

Equine will be kept on my propertyEquine will be boarded out somewhere other than my property

PROPERTY INFORMATION

If the equine will be kept on your property, how many acres will the equine be pastured on?   number
What type of shelter is available (barn/stall, loafing shed, windbreaks, etc? type
What type of fencing do you have?   type
What is the total number of equines on your property?   number

OFFP-SITE BOARDING PROPERTY INFORMATION

Name of Boarding Stable? full name
Owner's Full Name full name Telephone Phone Number

Address

Street Address

Street Address Line 2

CityState

Zip Code

Have you ever boarded an equine at this facility before?

YESNO

What type of shelter is available (barn/stall, loafing shed, windbreaks, etc?) Description
What type of fencing do they have?   Description
What is the total number of equines on their property? Number

ADDITION QUESTIONS

Your answers will help us determine the best placement possible

Is there a specific equine you want to adopt?*

YESNO

If YES, please describe the name, age, color and breed of the equine:

If NO, please describe what breed, size and gender you would prefer:

What type of equine do you wish to adopt?*

SEASONED: Calm, gentle, minimal handling issues. Could potentially be handled by a child or beginnerINEXPERIENCED OR GREEN: Has had inadequate training, but has good manners and is willing to pleaseUNTRAINED: May never have been adequately handled or trained, or maybe young

How do you intend to use the equine you want to adopt? (e.g. trail riding, dressage, jumping, etc.)

Owning an equine may cost $2,000 to $3,000 or more per year for care (feed, veterinarian, farrier, board, etc.). Are you willing and able to financially provide for this equine?*

YESNO

Have you sold or given away any equines in the past five years?*

YESNO

If YES, please describe the circumstance(s) and to whom?

REFERENCES

It is our practice to contact all references. These include personal acquaintances, veterinarians, and farriers. Please provide the names and phone numbers of two references (excluding relatives). We prefer references that are experienced with equines and that are also aware of your equine experience.

REFERENCE NO. 1

FULL NAMEFirst Name* Last Name* TELEPHONE Phone Number*

REFERENCE NO. 2

FULL NAME: First Name* Last Name* TELEPHONE Phone Number*

Do you currently have an equine Veterinarian?*

YESNO

If YES, please provide
Veterinarian's Name:  First Name   Last Name
Clinic's Name: Clinic's Name Telephone:  Telephone

Do you currently have a Farrier?*

YESNO

If YES, please provide:
Farrier's Name: First Name Last Name Telephone: Telephone

I attest that all the information in this application is true to the best of my knowledge.*

Date of Submission