| Full Name: * |
|
| Street Address: * |
|
| City: * |
|
| State: * |
|
| Zip Code: * |
|
| County: * |
|
| Home Phone: * |
|
| Cell Phone: * |
|
| Work Phone: |
|
| Email Address: * |
|
| Current Employer: * |
|
| Years With Current Employer: * |
|
| Employer Address: * |
|
| Employer Phone Number: * |
|
| Name of Nearest Relative Not Living With You: * |
|
| Relative Address: * |
|
| Relative County: * |
|
| Realative Home Phone: * |
|
| Relative Work Phone: |
|
| Relative Cell Phone: * |
|
| Relative Email Address: * |
|
| Equine Property Location (if different from your address) |
| Name of Facility: |
|
| Facility Address: |
|
| Contact Person: |
|
| Facility Phone Number: |
|
| Veterinarian Name: * |
|
| Veterinarian Address: * |
|
| Veterinarian Phone Number: * |
|
| Is this your current vet, or are you a new client?: * |
|
| Equine Professional Reference Name: * |
|
| Equine Professional Reference Address: * |
|
| Equine Professional Reference Phone Number: * |
|
| Equine Professional's Profession: * |
|
| If you chose other please explain: |
|
| Equine you are interested in adopting: * |
|
| How much time per week do you plan on spending with the equine?: * |
|
| What do you plan on using this equine for?: * |
|
| If for riding, how often and for how long?: * |
|
| Please list name and age of all riders if applicable: * |
|
| How many equines do you currently have?: * |
|
| Date of last vaccination of your equine(s): * |
|
| Vaccinations Received: * |
|
| Date of last deworming: * |
|
| Deworming products used: * |
|
| Date of last negative Coggins for all equine(s): * |
|
| Do you currently have any equines?: * |
|
| If no, have you previously owned any equines?: |
|
| If yes, how long ago?: |
|
| In the past 5 years have you given away or sold any equines?: * |
|
| If yes, please explain: |
|
| In the past 5 years have you had any equines pass away while in your care?: * |
|
| If yes, please explain: |
|
| Describe your experience with handling, caring for, riding, training equines: * |
|
| Who will be feeding the equine?: * |
|
| What do you plan to feed the equine: * |
|
| How often do you plan on having a farrier trim or shoe the equine?: * |
|
| How often do you plan on worming the equine?: * |
|
| How often do you plan on having a veterinarian visit the equine?: * |
|
| Where will the equine be kept?: * |
|
| What size are the barn stalls?: * |
|
| How often and how many hours will the equine be turned out for?: * |
|
| What size is the paddock/pasture?: * |
|
| What type and size of shelter is available?: * |
|
| What type of fencing surrounds the paddock/pasture?: * |
|
| How many other equines are present?: * |
|
| Describe any debris (limbs, metal, glass, trash, etc) present: * |
|
| Do you have plans to remove the debris?: |
|
| If no, please explain: |
|
| Have you ever been charged with or convicted of animal abuse?: * |
|
| If yes, please explain: |
|
| Applicant Full Name: * |
|
| Applicant Date of Birth (required for criminal background check): * |
|
| Co-Applicant Full Name: |
|
| Co-Applicant Date of Birth (required for criminal background check):: |
|
| |
By checking this box I acknowledge that I have read and understand the below statement regarding SCR Equine Policy.
|
|
I understand I am applying to adopt an equine from Second Chance Rescue. I understand that I must complete the application procedure and may have the equine property or boarding facility inspected and approved before being allowed to adopt an equine from SCR. I understand that I may not be able to adopt the equine I am interested in for various reasons.
In addition, I understand that SCR may perform a background check to verify my personal information as well as check for any criminal convictions. By signing this application, I agree that I have read and understand the Adoption Policy of SCR. I understand that I must submit a complete application in accordance with the policies before being considered as an adoptive applicant. I understand that if I adopt an equine from SCR I may be subject to follow up visits in accordance with the Equine Follow Up Policy. I also understand that in accordance with the Adoption Policy, I may never sell, give away, lease out, send to slaughter, etc. the equine I adopt. I also understand that I may never use the equine for breeding purposes. I also agree SCR is not liable in the event of injury, death or damage to any human, animal or property as a result of activities or actions of the equine I adopt.
I further agree to accept all responsibility for any action or lien resulting from any action, directly or indirectly involving said equine(s) while it is in my care.
I agree and understand that neither SCR nor its employees or agents will be liable for any damages or injury caused to me or any third person by the equine(s) once I receive delivery of it, including but not limited to damages or injuries caused by the fact that the equine(s) does not behave or perform in the manner I expected. Further, if any third person makes a claim against Second Chance Rescue or any of its employees or agents as a result of any conduct of the equine(s) in my possession, I agree to indemnify and hold Second Chance Rescue., its employees and agents harmless from any such claim, including costs and attorney's fee resulting from such claim.
Every effort has been made to disclose the history of these equines AS WE KNOW IT. These are rescued equines, and in some circumstances we may have little or no knowledge about the equine’s prior life or training. We will tell you everything we know about the equine however, we cannot make any guarantees about an equine’s temperament or training. It is advised that the adopter pay for vet check prior to adopting any equine.
Please Note: Applications will be processed and property inspections conducted (if necessary) as soon as possible. Upon final approval, you may come pick up your new equine in a safety approved equine trailer and there will be a $350 adoption donation (cash or credit card only) at that time.
|
| |