Equine Surrender Agreement

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date

Phone Number

Please enter a valid phone number.

Email

example@example.com

Equine Name

Breed age and Sex

How long have you owned?

What was equine previously used for?

Has this equine had any type of surgery?

Does this equine have any lameness issues if yes please explain

Current Vet name and number

Current farrier name and number

If equine is a mare, is there a possibility she could be pregnant?

Please describe the equine’s riding history.

Please describe the equine’s temperament, soundness, and any habits about which Healing and Hope Animal Foundation 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.)?

Is this equine a cribber?

	Date done
Coggins
E&W Encephalomyelitis
Tetnus
Flu
Rhino
Rabies
West Nile
Hoof Care
Dental Care

Please upload coggins and any medical records

Is this equine accustomed to pasture turnout?

How does this equine get along with others in a herd situation?

Does this equine stand easily for the farrier? if no explain

Does this equine trailer load easy? If no explain

Surrender Donation: Will you be making a tax-deductible donation to help cover the costs of caring for this equine while it is at Healing and Hope Animal Foundation? blanks If yes, the tax-deductible donation is for $ blank

Representations and Warranties
I hereby represent and warrant to Healing and Hope Animal Foundation, that the undersigned is the sole owner of the above described equine; has the authority to surrender this equine for adoption/placement or retirement at Healing and Hope Animal Foundation; that no other person or person’s signature is required to initiate a valid transfer of ownership and registration papers on this equine (if available); and that no other person or persons has any legal equitable ownership interest in this equine.
Delivery of Registration
I agree to deliver to Healing and Hope Animal Foundation a properly signed transfer of all registration papers, if available, for the above described equine, omitting the name of the transferee.
Other Pertinent Information and Consent for Contact
I also agree to provide Healing and Hope Animal Foundationwith all available information concerning this equine which might assist with finding the equine a future home. This information includes but not limited to health/vaccination records, previous owners’ identification, life events, and individual
personality traits. I also understand Healing and Hope Animal Foundation may contact previous owners, breeders, veterinarians, and farriers to obtain information to assist in placing the above referenced equine in a suitable home.
Surrender Rights
By executing this document I understand that I am giving up forever all rights to, titles to, and interests, regardless of the delivery or non‐delivery of registration papers, to the above equine voluntarily and without coercion or threats of any kind. I further understand that all future decisions regarding the placement of this equine will solely be those of Healing and Hope Animal Foundation. I also understand
if this equine is found to be unsuitable for placement for reasons determined by Healing and Hope Animal Foundation and/or a licensed veterinarian that the equine may either be retired at Healing and Hope Animal Foundation Sanctuary branch or euthanized. Lastly, it is understood that the surrendering party shall hold Healing and Hope Animal Foundation and all its officers, directors, employees, and volunteers harmless from any claims of damage, injury, or acts of negligence
arising from this surrender. This is a legally binding document for the irrevocable surrender of an equine for placement in an adoptive home by Healing and Hope Animal Foundation. Please read this document carefully and thoroughly before
signing. Take as much time as you need to consider this decision.

I have read the preceding and agree to all conditions set forth.

Name

First NameLast Name

Date

Signature