Horse Adoption Application 2010
Fill out the form below, and send it to: Mountain View Rescue
PO BOX 1542
Columbia, KY 42728
Fax- 270-384-5612
All applications must be accompanied by a $20 processing fee.
(If you do not adopt a horse, it will be considered a donation.)
NAME_____________________________________________________________
ADDRESS__________________________________________________________
PHONE #___________________________________________________________
E-MAIL____________________________________________________________
WEBSITE__________________________________________________________
Have you ever been accused or convicted of abuse to an animal or human? Yes No
VETERINARIAN’S NAME____________________________________________
PHONE #___________________________________________________________
CITY, STATE, ZIP___________________________________________________
ALTERNATE VET___________________________________________________
PHONE #___________________________________________________________
CITY, STATE, ZIP___________________________________________________
FARRIER & PHONE___________________________________________________
REFERENCES, Other than family
1.Name________________________Relation__________________Phone_________________
City & State_______________________________________Zip___________________
2.Name________________________Relation__________________Phone_________________
City & State_______________________________________Zip___________________
Marital Status:_____________________________
Current Employer________________________ Phone #_____________________________
Annual Household Income $_________________________
Background & Experience
What is your experience with horses? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
Have you owned a horse previously? Yes No
Have you had professional schooling or lessons? If so, what discipline, for how long, and when?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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How many other horses do you own? _________________Total
_____Mares _____Geldings _____Stallions _____Under age 2
Do you have experience training? (Explain in Detail)
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Do you live where the horse(s) will be kept? Yes No (if no, please explain) ________________________________________________________________________________________________________________________________________________
________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
Do you own a trailer? Yes No Have one I am able to borrow
Choices: Breed, Color, Age, Sex, Condition
Check the animals you would be willing to adopt, from the following list:
Old Blind Deaf Lame Abused
Pregnant Orphaned In need of medication Sound
Un-ridable Un-broke Green Broke Very Young
Any Size Any Breed Gelding Mare Unknown History
Would you be willing to give a retired, senior horse a permanent home, if need arises? Yes No
BREED CHOICE
1st Choice____________________________________________
2nd Choice____________________________________________
COLOR CHOICE
1st Choice____________________________________________
2nd Choice____________________________________________
AGE CHOICE
1st Choice____________________________________________
2nd Choice____________________________________________
Mare__________ Gelding__________ Height___________
I am flexible Somewhat flexible Not flexible
Name of horse you would like to adopt if applicable________________________
Horses will be adopted at least two at a time, unless you currently have other horses.
How many horses do you want to adopt? ________________
Most horses will need to be picked up within 1 week from the date of deposit. Will this be adequate time for you to provide transport? Yes No
If no, how much time will you need?
______________________________________________________________________________CARE
Shelter
1. Will the horse(s) be stabled? Explain.
2. How big is their shelter?
3. Explain shelter layout- (Please include diagram or pictures)
4. What type of fencing do you have? (Please include pictures)
5. How big is your enclosure? (Please include diagram or pictures)
6. How many horses will share this area?
7. How many hours will the horse(s) be outside per day?
8. How often will the horse(s) be exercised?
Nutrition
1. How may times per day will the horse(s) be fed?
2. What will their feed consist of?
3. Will they be separated at feed time?
4. Will they have access to a constant clean water source?
Maintenance
1. How often do you vaccinate your horses?
2. How often do your horses get wormed?
3. How often do you have your horses teeth floated?
4. How often are you horses feet trimmed?
5. What are your plans for this animal(s)?
6. Are you planning on breeding this animal(s)? Yes No
7. Are you able to handle the burial of a horse, if the need arises? Yes No
By filling out & signing this Adoption Application, I have every intention of adopting horses from Mountain View Rescue, and if my circumstances change I will notify Mountain View Rescue as soon as possible.
By signing the Adoption Application, I declare that all of the information that I have submitted to be the truth, to the best of my knowledge, and if found to be fraudulent, that I will be denied approval of adoption, and I could be held liable.
I have fully read and I understand the contents of the above Adoption Application and hereby certify that I am: at least 18 years of age, and I agree to abide by ALL of the policies, and rules concerning adoption, set forth by Mountain View Rescue, Inc.
Printed Name:___________________________________________________________
Signed:__________________________________________________Date:___________
Age:_______________________________
Signature of Parent or Guardian, if under18:____________________________________
(For internal office use only)
Date Received:________________________ Agent: _____________________________
Approved: ____________ Date: ______________
Denied: ______________ Date: ______________
Reason for Denial: _______________________________________________________________________
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