Surrender Form

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Click Here To Copy & Print Surrender Application

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Horse Rescue Foundation

SURRENDER APPLICATION

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.Name: _____________________________________________

Registered Name:_____________________________________

Breed: ____________ Gender: ________ Color: ____________

Registration Number (if applicable):_______________________

Date Foaled/Age: ____ Height: _____ Weight: ______________

Written Description: __________________________________

Notable Markings: ____________________________________

Brands/Tattoos/Scars/Blemishes: ________________________

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Date: ____________

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Current Owner: _______________________        Vet: __________________________

Address: ____________________________         Address: ______________________

City, State, ZIP: _______________________        City, State, Zip: _________________

Phone: ______________________________        Phone: _______________________

E-mail: ___________________

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Previous Owner: ______________________         Previous Vet: ____________________

Address: ____________________________        Address: ________________________

City, State, Zip: _______________________        City, State, Zip: ___________________

Day Phone: __________________________        Phone: _________________________

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Original Breeder: _____________________         Farrier: _________________________

Address: ___________________________          Address: ________________________

City, State, Zip: ______________________          City, State, Zip: ___________________

Phone: ____________________________          Phone: __________________________

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Are there any urgent medical needs or injuries that require immediate attention?  Please list all: _______________________________________________________________

Reason(s) for surrendering this horse to HRF: ____________________________

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A) YOUR HORSE’S HISTORY

Please attach additional written information about your horse’s history. Providing HRF with this personal information will benefit and aid in finding the most suitable adoptive home for your horse. Your time and attention is greatly appreciated and is extremely helpful.

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B) HEALTH: ____________________________________________

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C) Comments: ___________________________________________

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Last vaccination date: _________________        Vaccine Type: __________________

Last worming date:____________________        Wormer Type: __________________

Last date teeth floated: _________________       Last vet call date: _______________

Current medications/special care: ________________________________________

How often: _________________________         Why: ____________________________

Please list all known medical problems/conditions (allergies, spavins, broken bones, heaves, splints, etc.): __________________________________

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D) BREEDING

If horse is a mare, has she ever been bred?______ How many foals?_______ Last breeding?_______   If horse is a gelding, when was he gelded?______

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E) FARRIER

Last farrier call date: ____ Shod?____Trimmed?___ Type of shoes: _____

Corrective shoes or devices? ________ Reason for corrections: ________

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F) FEEDING

Current feeding pattern: Pasture: _______ Type: ________ Hours per day: ________

Hay type: ___________________ Amount: ___________ Frequency: ____________

Grain type: __________________ Amount: ___________ Frequency: ____________

Supplements or special feed?_____________________________________________

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G: SHELTER

Comments: __________________________________________________________

Pasture only: ______ Stall: _____ Run: _____ Turnout: _______ Hours per day: _______

If not now in pasture, has the horse ever been pastured?____ How long ago? __________

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H) TRAILERING

Comments: ___________________________________________________________

Has the horse ever been trailered? _________ Does the horse load easily?____________

How do you load the horse if there are problems? _______________________________

Trailer type used: Stock: _______ Side-by-side: _______ Slant: _______ Other: _______

I) BEHAVIOR

Please describe any behavioral issues including but not limited to cribbing, rearing, bucking, kicking, biting, etc. _______________________________________________

Please describe your horse’s temperament and how they get along with people and horses. Is your horse shy, dominate, outgoing, spooky, nervous, aggressive, mellow, friendly or other? ________________________________________________________________

Is the horse hard to catch? ____  If yes, how do you catch the horse? ________________

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J) TRAINING

Comments: ____________________________________________________________

Customary tack and bit used (bosal, hackamore, snaffle, etc.) ______________________

Tack or training aids – Likes: ___________    Dislikes: ____________________________

Type of activity (check all that apply):  Western Pleasure: _____  Trail: ____  Reining: ____            Cutting: ____   Roping: _____  Stock/Ranch Work: ____  Saddle seat: ____  Gaited: _____          Dressage: ____  Driving: ____  Hunter: ____  Jumper: ____  Division:____

Other:___________________________________________

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Professional training:

Type: ______________ Length of time: _____________ Trainer: _________________

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By signing this application, I certify that:

• I am over the age of 18 and I currently possess a brand inspection for this horse.

• I have disclosed all medical and behavioral issues as well as special care instructions for this horse to the best of my knowledge.

• I give” Horse Rescue Foundation” permission to contact the veterinarian listed on this application to obtain medical records and receive consultation in regards to this horse.

• All information contained in this application is truthful to the best of my knowledge.

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Signature: __________________________________   Date: ____________________

Print Name: _________________________________

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Click Here To Copy & Print Surrender Application

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