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Date: _______________________________________ |
Name of Horse: ___________________________________________ |
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Name of applicant: Address: City, State Zip |
Home Phone Work Phone Email address |
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Employer: Address Phone |
How long have you worked for Employer Annual Income |
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Do you own your home? Do you rent your home? |
Landlord name Phone |
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Will the horse be kept on your property? Yes________ No________ If no, list the name, address and description of the boarding/training facility: > > > Trainer/Manager and Phone: > |
If yes, please describe the area and shelter provided: > > > |
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Do you currently own a horse? Yes_______No_______How many?__________ |
If yes, please describe: > If you previously owned a horse, please explain what happened to it: > > |
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What type of horse are you spcifically interested in? Age: Breed: Height: Range of training: What is the height and weight of rider(s): |
Briefly describe your level of expertise in the following areas: Riding: NOVICE or INTERMEDIATE or ADVANCED or EXPERT Handling: NOVICE or INTERMEDIATE or ADVANCED or EXPERT Training: NOVICE or INTERMEDIATE or ADVANCED or EXPERT |
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Who will ride the adopted horse? Who will be responsible for feeding your horse? Who will train your horse? Who will be responsible for general care of your horse? > |
Have you ever tamed and/or trained a wild (feral) mustang, or similar horse? Yes____ No___ If yes, please describe the methods you used: |
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How much do you anticipate spending yearly for feed? Medical care? Worming? Farrier? |
How often will you worm your horse? How often will the hooves be trimmed or shod? How often will you have your horse's teeth floated? How often will you vaccinate your horse? |
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Who will be your veterinarian? Phone: Who will be your farrier? Phone |
What age do you expect your horse to live? Are you prepared to provide lifetime care for your horse? |
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Why do you want to adopt a horse? > > > Lifesavers would like to inspect your property/barn, when would be a convenient time? > > > |
Have you ever been issued a warning/citation for humane violation? Yes_____ No_____ If yes, please explain: > > |
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Please provide three references: |
1. Name: Phone: |
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2. Name: Phone: |
3. Name: Phone: |
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I agree to leave a non-refundable deposit of $100 which will be applied to the adoption donation. Balance due upon pick up of horse. | |
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I agree to attend a mandatory horse handling clinic or class held at Lifesavers within one month of adoption approval or forfeit my deposit and adoption. | |
| IF VOLUNTEERING AGAINST ADOPTION DONATION: I agree to volunteer at Lifesavers for a one month period at a credit of $5 per volunteer hour. I understand that I must schedule my volunteer hours with a staff member. Volunteer hours completed within one month period will be deducted from balance of adoption donation. If I do not keep my volunteer appointments I will be disqualified from volunteer program and must pay the full balance due less any volunteer hours completed or forfeit my deposit and adoption. | |
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I/We certify that all the information contained herein is true and correct. | |
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Signature: | |
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Date | |
Send donations to: Lifesavers, Inc., 23809 East Avenue J., Lancaster, California 93535
Phone for more information: 661-727-0049 or email lifesavers@wildhorserescue.org
© 1997 Lifesavers, Inc.