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Riding ______ Training _______Handling________Working with young unbroken equine._________ Please Elaborate regarding your years and types of experience,__________________________________ Equine Care. How much do you anticipate spending a year for Feed___________Farrier____________Vet Care_____________ How often do you feel an equine should be de-wormed? _________ How often should they receive farrier care________ What types of vaccinations should an equine receive? _________________ Just a few more (thanks for Sticking with it) DESCRIPTION OF HORSE TO BE ADOPTED: Be sure to list the horse name / registration number/Broker Number and description here. Name:___________________________Number ___________ Gender:________ Age:_____ Height:______ Breed:___________ Color:________________ Markings/Brands (identifiable marks):__________________________________ If this horse is unavailable will you consider others?_________ Are you flexible with your preferences?_____ Age____Size______Price_______Sex________Breed________Training Level_________ Are you willing to adopt and train an untrained or unhandled equine? ___________ If Yes Who will do the training?________CHNKWKS „ј‚TEXTTEXTŽaFDPPFDPPdFDPPFDPPfFDPCFDPChFDPCFDPCjFDPCFDPClFDPCFDPCnFDPCFDPCpFDPCFDPCrSTSHSTSHthSTSHSTSHhuЂSYIDSYID xSGP SGP xINK INK "xBTEPPLC &x BTECPLC Fx@FONTFONT†xˆSTRSPLC y:PRNTWNPRHy}________If yAdoption Application Voice For Horses Rescue Network (VFHRN) All information must be completely filled out ADOPTER S INFORMATION: * Name- First _____________________________ Last:___________________________________ Email address:___________________________ D.O.B________ Driver License#/state_______________ Telephone #: _____________ Cell Phone #:___________ Address:___________________City___________State____Zip_________ Employed by:____________________________Title:__________________ Address: __________________________________Telephone: ________ Have you ever been cited or convicted of Cruelty to animals or anything pertaining to animals___if yes, when? And please explain____________________________________________________________________________ Will the equine be kept at the above address? __________ If no, please provide the following information: Name of Boarding facility: __________________________ Owner s Name______________________ COMPLETE Address: _____________________________________ Telephone: ______________________Business_______________Contact person IF not OWNER Hours of operation:______________ The daily feeding will be done by __________________. If Boarding facility owner doesn't live at same Someone is at the facility during the hours of ___________ The boarding facility is ________miles from my residence. I intend on seeing my horse_______________ Number of acres equine will be pastured on? __________________Total Number of Equine on Property______ Breed and sex of other Equine on property______________________________ Other Animals on Property equine is housed_______________ The type of corral/paddock, and or pasture size which will be provided is:(Please provide picture) Be detailed Types______________________ ___________________ ____________ Are you willing to adopt an abused or neglected equine?___________ I_________(Intial) are aware VFHRN has never handled or evaluated any Broker Horse and has very limited knowledge of the horse's condition training or abilities ? Any Special Needs:_________________________________________________________________ Initial (____) What do you intend to use this horse for?_________________________________________ Will you be Riding English or Western? _____________________Will She/he be used as a school horse? _____ If yes, Please explain the type of work and how many hours a week the work will be done. _____________________________________________________________________________ How many people will be riding the Equine? _________ Approximate Size and weight of riders____________ ______________ ______________ __________ _________ Do you object to our checking the property intended for the equine before adoption and/or inspections after adoption?____ If Yes Explain?_______________ Do you Understand that Pictures of Equine adopted and updates are required within 45 days of adoption?_________ Are you willing to supply updates including medical records /reports pictures when requested ?______ Waiver of Liability By signing below, the Adopter understands that ________(initial) (VFHRN) makes no representations or warranties concerning this horse including but not limited to the condition, health, temperament, soundness, or fitness for particular purpose. We have never seen or interacted with the horse. I further agree that Releases are not liable for the mistakes and/or negligence and/or intentional acts of service providers and/or contractors such as livestock haulers, veterinarians, or handlers who may at any time be in the care, custody and control of the horse I am adopting. I understand that I may pursue claims against such third parties for any damages caused by mistakes, negligence and/or intentional acts of such third parties during the time that my horse is in their care, custody and control. Signing this application authorizes ________(initial) (VFHRN) to contact the listed references and inquire about your equine experience. THIS AGREEMENT IS NOT AN AGREEMENT OF SALE BUT IS AN AGREEMENT OF POSSESSION. Adopter shall provide all food, water, shelter, farrier, and veterinary care as is necessary to maintain said equine in good health and safety and shall provide a quality environment free of abuse, neglect, poor handling and/or mismanagement for remainder of said equines lifetime. Adopter shall keep VFHRN informed of all changes to (both equine and Adopter) name, address, and phone necessary to insure the protection of said equine and to enforce the provisions hereof. VFHRN retains the right to inspect any facility where said equine is kept at its discretion and without notice. If assigned agents of VFHRN determine that abuse or neglect exist, they retain the unilateral right to repossess said equine immediately or at such as may be required by the circumstances. Should VFHRN fail to immediately repossess the subject equine upon findings of abuse and/or neglect, such failure does not constitute a waiver of its right to do so subsequently. Initial (_____) If harm and/or death of said equine result from any act of omission, neglect or otherwise preventable situation, Adopter shall be liable therefore. Adopter agrees to pay any and all reasonable attorney's fees and all court costs of VFHRN in the event any matter arising under this agreement is forwarded to any attorney for enforcement of VFHRN rights and remedies under this agreement. Adopter shall be required to provide medical and farrier records/receipts showing proof of vaccinations, de-worming, dental work, farrier work, etc., for said equine at the request of VFHRN. Adopter is urged to notify VFHRN in any instance of severe medical problems and injuries of said equine. Adopter shall notify VFHRN of said equines death and may be required to provide a death certificate signed by a veterinarian. In the event of a divorce, separation or disillusion the said equine will remain with the adopter who has signed the adoption agreement. If VFHRN feels the equine is in danger during this situation VFHRN may/will remove the said equine from the possession of the adopter and or property to ensure its safety. In the event of the death of an adopter who has signed the agreement, VFHRN is to be notified and the horse must be returned back to VFHRN unless other arrangements have been approved by VFHRN President. It is agreed that if you cannot longer care for the animal then you MUST bring it have it returned at ADOPTER's EXPENSE to the rescue________(initial) VFHRN may update its records and monitor the whereabouts, health and safety of the horse. In the event Adopter cannot or will not continue care for said equine sole ownership and custody of said equine will automatically revert to VFHRN and/or agents and/or assigns and must be transported at adopter's expense Back to VFHRN Adopter will complete a copy of the within Application and Agreement, and the subsequent Adopter shall be bound be the terms thereof. Finally, the undersigned agrees that this animal will not be resold at any type of auction, horse broker, feed lot or slaughter destination, given away, bred, traded, leased. In the event the undersigned fails to comply with the terms of this Application and Agreement, __________(initial) VFHRN reserves the right to commence legal proceedings to recover the horse, and the undersigned shall be liable for all costs including damages to _______(initial) VFHRN is assumed at a minimum of $5,000.00, inclusive of attorney s fees, in connection with such legal proceeding. This agreement is accepted by: Signed_________________________________________ Date________ *Adopters signature warrants that the Adopter is at least 18 years of age at the time of signature and acknowledges receipt of the Processing Terms and Conditions contained within this agreement and understand that VFHRN holds the right to refuse services to anyone for any reason. Initial (________ ) REFERENCES: 1. Name:__________________________________ Telephone: (____)______-________ Comments:__________________________________________________________________________ _______________________________________________________ email address____________________________________________ 2. Name:__________________________________ Telephone: (____)______-________ Comments:______________________________________________________________ ________________________________________________________________________ email address____________________________________________________________ 3. Name:__________________________________ Telephone: (____)______-________ Comments:______________________________________________________________ ________________________________________________________________________ email address___________________________________________________________ 4. Name:__________________________________ Telephone: (____)______-________ Comments:______________________________________________________________ email address____________________________________________________________ 5. Farrier:__________________________________ Telephone: (____)______-________ Comments:______________________________________________________________ email address___________________________________________________________ The equine veterinarian who will care for this animal is: Name:__________________________________________Telephone: (____)__________-_______ Comments:______________________________________________________________ email address____________________________________________________________ The Name and Number of your Equine Dentist is Name:_______________________________Telephone: (____)_____-______ Comments:______________________________________________________________ ________________________________________________________________________ email address____________________________________________________________ Name and Number of your local Humane Society/ Animal Control is (if no Humane Society then the number of your Local Police Dept) Name:________________________________ Telephone:(_____) ______-___________ Comments:_____________________________________________________________________________________________________________________________________ email address____________________________________________________________ *this application/agreement is transferable to any broker/rescue horse adopted through VFHRN. 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