Equuvation Equine Donation / Lease Form [r.2019]

Equine Donation Form

Items marked with an asterisk require a response.

If you are interested in donating a horse to our program, please read through the notes below and complete this application in full. All submitted applications are reviewed by our Board of Directors on an ongoing basis. SUBMISSION OF THIS FORM DOES NOT GUARANTEE ACCEPTANCE INTO OUR PROGRAM.

Donated horses must:
• Be safe to work with on the ground and under saddle
• Have a current negative Coggins
• Be up to date on de-worming and vaccinations (copies of all records will be requested)
• Be up to date on trimming
• Have all registration papers and records surrendered to Equuvation
• Be transported to Equuvation facilities by the donating party

If the owner wishes to take a tax deduction of $5,000 or more, the IRS form 8283 provided by the donor must be completed and filed, including an appraisal summary. This is made on Schedule B IRS Form 8283, and needs to be signed and dated by the charity and a qualified appraiser, and contain information specified in Schedule B relating to the donor, the horse, the donee and the appraiser. The burden of proof of the horse's value lies with the original owner.

DONATION APPLICATION

TODAY"S DATE*

Date

Owner's Name*

Mailing Address*

Home Phone*

Mobile Phone*

Work Phone*

E-mail Address*

When is the best time to reach out?

What is your preferred method of contact?*

PhoneE-mailEither

Horse Name [Registered]*

Horse Name [Stable Name or Nickname]*

Breed*

Age/DOB*

Sex*

Height*

Weight*

Color*

Markings*

Blanket Size

Saddle Tree Size

Registered With (if applicable)

Registration Number (if applicable)

Tattoo or Brand (if applicable)

Market or Appraisal Value of horse at time of donation:*

Horse is currently stabled at (please provide full address):*

Owner of Boarding Stable [name, phone and email]

Current Veterinarian [name, phone and email]*

Current Farrier [name, phone and email]*

Current feed and hay [type, amount and schedule]*

Current medications and/or supplements [type, amount and schedule]*

How is the horse presently kept on a daily basis? [i.e. turnout 24/7, stalled for a certain amount of time each day, with or without turnout buddies?]

Will this horse come with any tack or blankets? If so, please describe below:*

Please fill in the last date that each of the following was completed:

Wellness Exam by Vet:*

Coggins:*

Strangles Vaccine:

Rabies Vaccine:

West Nile Virus Vaccine:

EW Encephalitis Vaccine:

Rhino-Flu Vaccine:

Tetanus Vaccine:

Potomac Horse Fever Vaccine:

Influenza Vaccine:

Teeth Floated:*

Wolf Teeth Removed:

De-wormed:*

Fecal Tested:

Hoof Trim/Shod:*

Other

Please describe any special shoeing or trimming requirements for this horse:

Has this horse suffered any major soft tissue or skeletal injury during the time ownership? If yes, please explain in full.*

Has this horse suffered any bout of colic or abdominal surgery during the time ownership? If yes, please explain in full.*

Has this horse suffered any incident of founder during the time ownership? If yes, please explain in full.*

Has this horse been diagnosed with any chronic illness or condition during time of ownership? If yes, please explain in full.*

List and describe and behavioral, mental, emotional, training or physical quirks of the horse:*

List and describe and training and showing experience of the horse:*

Describe reason for donation:*

How quickly [or by what date] do you need to place this horse?*

If our program is not able to take donation of this horse at this time, would you like us to refer you, and/or share this horse's information, with other reputable therapeutic centers who we would recommend?*

Yes, please send this info to other centersNo, I would prefer to reach out to other centers myselfUnsure

If this horse is accepted into our program, would you like to be notified if he/she passes away?*

YesNo

Other comments or notes:

Please upload at least 2 images of the horse [max file size 5MB]:

Select File

If you have trouble uploading images, they may also be emailed to equuvationinc@gmail.com. Donation applications will not be considered until images have been submitted; unless an Equuvation representative has already met the equine.

By submitting this form, I, the undersigned donor of the above described equine understand and agree to sign a contract that recognizes the below statements;
• I am giving up all my rights, title, and interest in the above described equine to Equuvation;
• There are no liens or claims against the equine, and if any liens or claims are found, I will be solely responsible for them and will indemnify Equuvation from all damages Equuvation may suffer due to the initiation of legal proceedings brought against myself and/or Equuvation arising from my former ownership of the above described equine;
• I am releasing this equine completely and voluntarily;
• I understand that Equuvation will use its best judgment and ability in handling any situation that may arise in the best interest of the equine;
• I understand that once I release the equine, I will not have any control over the equine’s care;
• I understand that Equuvation will not accept the equine until I have signed and returned this contract, and have provided Equuvation with a copy of all of the equine’s veterinary records and a negative Coggins from within the previous twelve (12) months;
• I understand that Equuvation may decline to accept the donation of this equine at any time until the equine has been officially accepted into the program.

Many times an equine owner will choose to donate a small cash gift (one-time or monthly reoccurring) along with the equine to sponsor their arrival into the program. This donation is fully at the discretion of the equine owner. All donations are tax-deductible and the donor will receive a receipt for their records.

BY TYPING YOUR NAME IN THE BOX BELOW, YOU CERTIFY THAT ALL OF THE INFORMATION THAT YOU HAVE PROVIDED ON THIS APPLICATION IS TRUE AND CORRECT, AND YOU HAVE READ THROUGH AND UNDERSTAND THE COPY ABOVE.*

TODAY"S DATE*

Date

Thank you for taking the time to complete this donation application. Someone from our organization will be in touch within 48 hours.

If you have any questions, please don't hesitate to contact us at: equuvationinc@gmail.com -- thank you!

www.equuvation.org | www.rcdiscoverytrail.org