You are responsible for transporting the horse from our facility after we have approved your application and within a reasonable time. However, if you are in our immediate area we may be able to arrange transportation for the horse for a small fee depending on the mileage.
SPECIAL NOTE: Placement donations (does not include transporting fee) is based on the condition
and rideability of the horse.
Your Name: _________________________________________
Address:___________________________________________
Home Phone:________________________
Work Phone: ______________________
Email Address:______________________________________
What gender do you prefer?
Gelding ____
Mare____
Colt_____
Filly____
Doesn't matter or undecided____
What age do you prefer?
Please specify _______
Doesn't matter or undecided____
What color or breed do you prefer?
Please Specify_________________________________
Doesn't matter or
undecided____
How tall would you prefer?
under 14 hands______
14-15 hands_____
15-16 hands____
16+ hands_____
What Build do you prefer?
Small____
Medium_____
Large____
Would you be interested in a special needs horse? Yes() No()
Some background info on you.
What would you use the horse for?______________________________________(i.e., Pleasure riding , Driving , Showing , Handicap or Youth Program , Other (please explain)
Responsibility for care of horse
Have you ever had a horse before? Yes ( ) No ( )
If yes ,how long and how many ? (note: if you no longer have the horse(s) please briefly explain what happened to the horse.
_________________________________________________
_________________________________________________
Will the horse be boarded on your own property? Yes ( ) No ( )
If no , where will the horse be kept?
____________________________________________________________________
Describe in detail the place where you will keep the horse.__________________________________________________________________
_________________________________________________________________________
_________________________
What is the size of the turnout area?
______________________________________________________
Kind of fencing provided?
______________________________________________________________
How long will you turn the horse out each day?
______________________________________________
The name of the primary person to be responsible for the horse?
_________________________________
Is this person knowledgeable about horse care?
_____________________________________________
What type of hay do you plan to provide and how much per day?
_______________________________________________________
_________________________
What type of grain do you plan to provide and how much per day?
_________________________________________________________
_______________________
Will the horse have free access to clean water at all times?
___________________________________
Hopeful Haven Equine Rescue Organization, requires references in order to consider placement of our horses. Please do not use immediate family members.
What is the name, address, & phone # of your current vet?
__________________________________________________________
Are your current horses up to date on their Coggins, Vaccinations?
Yes ( ) No ( ) I need to Update them ( ) (Note: We will need copies of these updated items once we approve your application)
How long have you used this vet?
______________________________________________________
What is the name, address and phone # of your farrier?
________________________________________________________
How long have you used this farrier?
___________________________________________________
Personal Reference Name, Address, Phone, how long have you known this person:
1.
______________________________________________________________________________
2.
______________________________________________________________________________
**Miscellaneous Information**
Please list any animals you currently have:
___________________________________________________________________________
Are you interested and capable of caring for an injured horse ( ) Yes ( ) No
Would you be interested in Fostering a horse in your home until the horse is adopted ( ) Yes ( ) No
( If you choose yes we will send you a Foster Agreement to fill out and return to us)
We will make a preliminary visit to your home or place where the horse will be kept before the initial
placement. This is to ensure that the horse has a good safe home to go to. If you have anything else you would like to add please note this on the back of this application.
Please read the following carefully ( Note: Hopeful Haven Equine Rescue Organization, Inc AKA H.H.E.R.O)
The applicant agrees to the following stipulations and conditions concerning acquiring a Horse(s) through H.H.E.R.O's "Home Bound Program".
I. Once applicant acquires the horse(s), the horse(s) then remains the property of Hopeful Haven Equine Rescue Organization, Inc for one (1) year from the date the horse is placed in his/her care. After this time the named horse will be fully transferred to the applicant.
II. If after one year the applicant decides to sell, breed, give away, dispose of, or transfer the named horse out of his/her care, we ask that he/she would first consider returning the named horse to H.H.E.R.O.
III. Should a life threatening situation arise within the one year period H.H.E.R.O must be notified prior to any thought of euthanization. IV. Once a placement of named horse is arranged, the transportation costs are the responsibility of the applicant.
V. The applicant may not release the horse from his /her care within the one year period. If stabling is relocated, H.H.E.R..O must be notified by phone or mail and give approval prior to moving the horse.
VI. Required Weight and condition: Named horse(s) must maintain the required weight and condition as advised by a licensed veterinarian.
VII. Required Care: Horse needs proper feeding to maintain appropriate weight, free access to water, a minimum three sided shelter, and adequate fencing.
Required Veterinary & Farrier Care Required Veterinary & Farrier Care
Worming and Hoof Care: Worming done every eight (8) weeks. Hoof care done every 6- 8 weeks.
April 1: Spring Inoculation: Eastern /Western Encephalitis, Tetanus, Rabies, Dental Care, and and any other inoculations your vet recommends be done for endemic diseases.
October 1: Fall Inoculations: Flu, Rhino, Dental Care, and any other inoculations your vet recommends be done for endemic diseases.
Inoculations must be administered by a licensed vet for the first year after placement. If you choose to vaccinate your own horse after this time, please state which vaccinations you will administer and how often.
Illness or Injury
The applicant agrees to provide recommended vet care for illness and/or injury according to the horse's needs and/or according to the requirements of ____________________County /Parish ordinance and/or State _________________________Law.
VII. The applicant agrees to forward a vet's brief statement of the horse's residence, condition, weight, teeth and hoof conditions at the time of the Spring and fall Inoculations or upon request ( a health check card may be sent you by H.H.E.R.O for this purpose)
VIII. The following requires notifying H.H.E.R.O within 24 hours:
A. Serious injury or illness that could be life threatening.
B. Death of the horse. A statement from a vet stating the present apparent cause of death must be forwarded to H.H.E.R.O. Euthanization is not your opinion. H.H.E.R.O reserves the right to approve or deny recommendation to
euthanize the horse.
IX. The applicant agrees and understands that the applicant and/or placement fees is non-refundable at any time during or after the placement of named horse.
X. The applicant agrees the named horse will reside at:
Address :
_______________________________________________________________________
Directions can be given here
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
If the applicant fails to comply with any of the conditions and or stipulations set here, Hopeful Haven Equine Rescue Organization, Inc reserves the right to regain possession of the named horse. The applicant also agrees to hold harmless any employees, volunteers, former owner of horse for any negligence, damage or injury received by any person or property by named horse. In addition, horses placed by H.H.E.R.O include no guarantees pertaining to condition, temperament or soundness.
The applicant aggress to permit a representative of H.H.E.R.O to visit the stabling property at any time and the named horse with prior notice and return horse to H.H.E.R.O. if representative feels situation is undesirable for the well being of the named horse.
A copy of this agreement will be sent to you by regular mail, after the following has been met:
Application fee paid $5.00 ( return this with your initial application)
Placement Fee ( to be determined by H.H.E.R.O)
The application has been signed by both parties
Placement of horse has been established
If you agree to the terms and conditions in this application please sign below:
I, _____________________________________________ have read and
( Applicants Name )
accept the terms, conditions and stipulations mentioned above that pertain to the acquiring of named horse:
Date of signature ______________
************* DO NOT WRITE BELOW THIS LINE *************
*Horse's Name:___________________________
*Breed :_________________________________
* Color ________________________
* Markings______________________________
* Identification ___________________________
*Approximate Age ________________
* Sex _______________
*Special Needs/Concerns:_______________________________________________
______________________________________________________________
*Ride-ability:__________________________________________________
*Weight at time of placement:_________________
*Feeding directions explained to adopter:
__________________________________________________ Adopter Initial _______
Check list of application procedures
Application Fee Received Yes ______ Date________ No________
References checked ___________ by ___________
Vet?______________________________________________
Farrier?__________________________________________
Personal?_________________________________________
Site inspection:
Approved ___________
Disapproved _________
Why?__________________________________
______________________________________
Placement fee received ( to be determined by HHERO)
$ ______________ Date_____________ Method ___________
Transportation Cost Added $___________
for miles __________ to ___________________
This application had been signed by both parties:________
Copy of application has been given or mailed to Applicant:
Date Mailed _______________ By:_____________________________
I , ________________________________ a Hopeful Haven Representative hereby authorizes and approves this placement of the above named horse to applicant.
Date Approved _______________
Thank you !!
