Surrender Form

Surrender Form
Before you start, please sign by each statement below stating you have read and agree to the following:
I understand that filling out this form does not guarantee my surrender will be accepted by The Kentucky Equine Adoption Center.*

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I hereby surrender the below named equine(s) to the Kentucky Equine Adoption Center, Inc., and thereby relinquish all ownership of the equine(s). I represent and warrant I have the right to deliver the equine(s) to the Kentucky Equine Adoption Center, Inc. I understand that the Kentucky Equine Adoption Center, Inc. will not be responsible for any financial obligations incurred by the owner(s) on behalf of this equine(s) prior to its surrender to the Kentucky Equine Adoption Center, Inc. By signing below, I waive any waiting period before disposition of the equine(s). Should the Kentucky Equine Adoption Center, Inc. find a suitable home for the equine(s), I understand that I am consenting to adoption of the equine(s) by an individual/organization as determined appropriate in the Kentucky Equine Adoption Center, Inc.’s sole discretion. I understand and agree that I am transferring full ownership of the equine(s) to the Kentucky Equine Adoption Center, Inc. and the Kentucky Equine Adoption Center, Inc. has full authority for all necessary veterinary procedures.*

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I acknowledge that necessary veterinary procedures may include a veterinarian’s determination that euthanasia is appropriate given the equine’s physical and/or mental condition. Having given full consideration to the terms of this agreement, and understanding my obligations and waivers pursuant thereto, I have decided to relinquish the equine(s) to the Kentucky Equine Adoption Center, Inc., and agree to all terms of this agreement by signing below.*

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Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Driver's License #*
Driver's License State*
Name Of Equine*
If you are inquiring to surrender multiple equines, please fill out a separate form for each.
Is this equine registered?*

YesNo
If registered, please state registered name and what association it is affiliated with.
If registered, please upload a copy of registration papers.

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If applicable, please provide registration number.
If applicable, please provide tattoo or brand.
Age Of Equine*
If this is an estimated age please note.
Breed*
Sex*
Is this equine microchipped?*

YesNo
If microchipped, please provide microchip number.
How long have you owned this equine?*
What was this equine's previous use?*
If equine has been ridden in the past, please describe riding/training history. *
Please explain the situation that led you to consider surrender.*
Has this equine had any past surgeries?*

YesNoUnknown
If you answered yes to the question above, please provide details.
Does this equine have any known medical issues or injuries?*

YesNoUnknown
If you answered yes to the question above, please provide details.
Does this equine have any lameness issues or need corrective shoeing?*

YesNoUnknown
If you answered yes to the question above, please provide details.
Does this equine have any special dietary needs or require daily medication?*

YesNoUnknown
If you answered yes to the question above, please provide details.
What is your horse currently eating and the amount each day? Any supplements?*
If the equine is a mare, has she had a foal previously and/or is there a possibility she could currently be pregnant?

YesNoUnknown
If you answered yes to the question above, please provide details.
Please describe the equine’s temperament, vices, and any other habits about which the Kentucky Equine Adoption Center, Inc. and its adopters should know.*
Does this equine’s temperament, soundness or habits pose any danger to those riding or handling it (e.g. bites, kicks, rears, bucks shies at vehicles, will not trailer without tranquilizer, etc.)?*

YesNo
If you answered yes to the question above, please provide details.
Has this equine ever injured anyone?*

YesNo
If you answered yes to the question above, please provide details.
Is this equine a cribber?*

YesNo
Is this equine prone to choke?*

YesNo
Has this equine coliced in the past?*

YesNo
If you answered yes to the question above, please provide details.
Please list dates of equine’s last vaccinations, worming, hoof and dental care. If unknown, please type "unknown"
E & W Encephalomyelitis*
Tetanus*
Rhino/Flu*
Rabies*
West Nile*
Botulism*
Dewormer*
Farrier*
Dental*
Please provide a copy of current coggins. *

Please note, all horses entering The Kentucky Equine Adoption Center must have an up to date negative coggins.
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Does this equine have a current health certificate?*

YesNo
If you have a current health certificate, please provide a copy.

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Anything else we should know that was not mentioned above?
Any other documents we should have that were not provided above?

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Please provide at least one photo of the equine. *

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Additional photos or videos can be provided below.

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Additional photos or videos can be provided below.

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Additional photos or videos can be provided below.

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To the best of my knowledge, the above information is true and correct.*

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There is no fee to surrender a horse; however, we do appreciate donations. A
suggested donation of $200-$500 will cover the intake exam, and any diagnostic
testing that needs to be done.
Donation

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