Date: __________________

Name: _________________________  Home Phone: ______________________

Address: __________________________________City:________________ Zip:_________________

Work Phone: _______________________Email Address:  ___________________

Employer: ____________________________His Phone:________________

Annual Income: Self: _____________ Household: ______________

About You:

Do You?   Rent                    Own              Live w/ Parents:

Landlord’s Name: ___________ Landlord’s Phone #: __________

Do you currently own a horse (how many?)?

What is your price range (donation amount) for adopting a horse (what is your budget)?

Describe your experience with horses (riding/handling/training): 

 What do you plan to do with the horse you adopt from Meadow Haven Horse Rescue? What would you do with it if it becomes lame or old?

What Breeds Are NOT Acceptable? 

What Breeds ARE Acceptable?  (Mules?  Miniatures? Gaited horses?)

Name of horse you wish to be considered for:

If there is no particular horse that you have chosen, please give us as much information to help us find you the perfect match: 

Do you have specific height, age, weight, sex or performance requirements? What are they?

What are your riding skills (Beg., Int., Adv.)?

Who will be the primary rider of the horse?

Would you consider a horse with special needs (please keep in mind that with rescuing horses comes a high chance that there could be emotional or physical problems, so consider this question carefully)? Yes   No                                              

List all type of limited needs that you are not willing to take:

Will the horse be kept on your property? Yes:     No: 

Describe where the horse will be kept (structure/shelter/other horses/security).

 If the horse will be kept at a boarding facility, please tell us where the horse will be Housed? Owner’s Name: _____________________________Phone:_______________

Address:__________________________________________________

When will it be convenient to visit this facility?

References:                          Name                                    Phone

Veterinarian:

Farrier:

Trainer:

Other:

Have you ever been issued a warning or citation for humane violations? Yes   No  

If yes, please explain the disposition on a separate sheet of paper.

 I certify that all the information contained herein is true and correct:

Signature: _________________________ Date: ________________

I certify that I am over 18 years of age:_________(initial)*Note, by signing this contract, you are releasing MHHR and it’s volunteers from liability for any injury or loss when on their property or hosted activity. Horses are animals and injury can occur when handling, riding and working with them. This release of liability will be in effect for signer and family when applicable. This will remain in effect at all times. Each individual not related to signer should complete a separate release form. By Texas Law, an Equine Professional can not be held liable for accident or injury in equine related sports activities.

General Info:

Horses come to the shelter weekly- some have histories, some do not. We try to check the horse as carefully as possible for training abilities and sickness. All are wormed and vaccinated before leaving. A vet log and medical history will be supplied when available. We can not “guarantee” any horse who enters and leaves, but we do try to make the best match as possible with the new owner. Should a match not be suitable we will take the horse back and find a new placement, however, donations to the sanctuary are not returned. Some horses may need to be picked up directly at the owners.

Do you have a trailer you can use to do this? Yes    No

Adoption: Some of the adopted horses may be resold AFTER 6 months for a value more than slaughter price, but never at an auction. Meadow Haven must be notified of the owner immediately. Elderly horses/special needs horses must be returned to the sanctuary or have the new owner approved by filling out a new application form. This is only to prevent the horse from going to the wrong home- and possible auction. These horses are much more at risk.

Fostering- If you would like to foster you agree that you will be responsible for all bills entailed with the upkeep of the animal. Your costs associated with it may be tax deductible (check with your accountant). Unfortunately we are unable to reimburse the costs at this time, due to lack of donations. We do require your commitment to keep the animal in a secure place, with shelter, proper feed and exercise, wormed and vaccinated and hoofs trimmed every 8 weeks. We can supply the wormer and we can vaccinate (we do NOT reimburse these expenses but can do it ourselves).  You understand that if the horse needs emergency medical attention, you will have to provide it at your own expense. The horse must be available to be viewed by possible adoptive parents. You will have full use and enjoyment of the horse. You will have the opportunity to be the adopter (1^st choice), at a very, very low adoption fee. If the horse is adopted out, you may be asked to take another one immediately.