APPLICATION TO ADOPT
NAME
ARE YOU OVER 18yo?
ADDRESS
HOME PHONE
WORK PHONE
FAX
CELL PHONE/PAGER
EMAIL ADDRESS
Please answer the following questions completely. Please check all that apply.
Return completed application via:
email: LFHorses@verizon.net or
fax: (717)650-3219
Please answer all questions you can, it's okay if you don't know the answer to a question we can always help you with questions and concerns.
1.Applicant’s Horse Experience? experienced/somewhat experienced/limited in experience/ inexperienced.
Please elaborate:
2. Have you ever adopted from a rescue before?
3. In the event the horse has behavioral issues:
? I am experienced and intend to train the equine.
? I will to hire my own trainer to retrain the equine.
? I would like to hire a trainer, but do not know of any.
6. Please list any/all other equines and/or animals you now have, the type, their names and their ages:
8. Will this horse be provided with an equine companion? Yes/No If yes, how many?
9. What shelter will be provided for the equine?
? Barn , give stall size
? Run-In Shed, give shed dimensions
How many horses will rely on this shed for shelter
10. What type of fencing encloses the turn-out area?
11. How large is the turn-out area How many horses will be turned out in this area
12. How long will the equine be turned out each day?
13. Feeding Schedule, please complete all information:
What type of Hay
Quantity/Frequency
Describe Storage
What type of Grain
Quantity/Frequency
Describe Storage
14. How will clean water be provided?
15. Describe the maintenance program and schedule you will implement to care for the equine:
Worming/Parasite Control
Farrier/Hoof Trimming/Shoeing
Dental/Float Teeth
Shots/Immunizations
APPLICANT REFERENCES (please do not use immediate spouses, significant others or any family members)
Veterinarian How long have you used this vet?
Farrier How long have you used this farrier?
Dental How long have you used this dentist?
General How long have you known this person?
General How long have you known this person?
Why are you interested in adopting a horse?
Lifelines Farm would appreciate receiving pictures of the shelter and turn-out area where you intend to board the equine. We would also appreciate pictures of any animals you own now. These pictures can be sent via email. A home visit will be scheduled as well.
Thank you for your interest, and please note that your application should be processed in the next 7 days.
Signature of applicant or person responsible for the equines care if primary caregiver is under 18 years in age:
____________________________________________________________ (Signature)
___________________________________________________________ (Print name)
______________________________ (Date)
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For Office Use Only:
Approval Status:
Equine:
Applicant:
SS:
Paypal ref#:
Date of Placement:
FollowUp visits completed: <name, date, and observations>
Was adopter added to our adopters yahoogroup?
2 week follow-up notes
3 month follow-up notes
6 month follow-up notes
1 year follow-up notes
Annual follow-ups