Horse Owner Surrender Form
anyone who wants to surrender a horse to our rescue needs to fill out the below form and email it to us at KellyLv6@aol.com
We will only accept a horse if we have the room. Otherwise we will place the horse on our website and our facebook page to help the owner network to find the horse a new home!
Horse Information: Horse Nickname _______________________ Full Registered Name ___________________________ Registration Association and # ________________(original breed papers with signed transfers must be submitted with this form) Breed _____________________ Age _______ Gender______________ Color__________________ Descriptive Markings and Brands: _________________________________________________________________________________________________ _________________________________________________________________________________________________ Current Owner Information: Current Owner ___________________________________ Street Address ___________________________________ City ___________________ State _____ Zip Code _________ Home Phone ____________________ Cell Phone ______________________ Work Phone ____________________ Email ______________________________________ How long has this horse been with the current owner? ___________________ Reason for surrendering this horse to Charming Acres Rescue? Charming Acres Rescue does NOT judge people based on their reasons for surrendering their equines. __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Medical and Temperament History: Most recent vaccinations including date administered: _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ Most recent worming including date administered and product used: ___________________________ Does this horse have a current negative Coggins test? [ ] Yes [ ] No (if so, original Coggins test must accompany this form) Has this horse been vaccinated for West Nile Virus within 6 months? [ ] Yes [ ] No Does this horse stand tied? [ ] Yes [ ] No Does this horse load into a trailer? [ ] Yes [ ] No Does this horse lead? [ ] Yes [ ] No Does this horse clip? [ ] Yes [ ] No Does this horse stand to be bathed and groomed? [ ] Yes [ ] No Does this horse stand for the hose? [ ] Yes [ ] No Does this horse stand for the farrier? [ ] Yes [ ] No Does this horse stand to be wormed/vaccinated? [ ] Yes [ ] No Is this horse broke to ride? [ ] Yes [ ] No If yes, in what situations has this horse been ridden? __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Known unsoundness, lameness, or other medical conditions: (please attach any veterinary or other health provider documentation) __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Current treatment or veterinarian recommendations: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Any known feed or medication allergies? _________________________________________________________________ Please list all known special needs, overall temperament, any likes/dislikes, quirks, vices, and any other necessary or useful information. This information will help us with the rehabilitation process, if needed, and helps keep our trainer, staff and volunteers safe. __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ please write up a brief (or not so brief) history of this horse. Also, if you have any preferences for the type of adoptive home you would like to see this horse go to, let us know. We can’t promise specifics when placing horses into new homes; however we do try to take into account the type of situation owners would like to see their horse go to. Release: I , _________________________________________, agree that the above information is true to the best of my knowledge and that I am the legal owner of the above described horses. I understand that by signing this form, I agree to surrender legal ownership of my horse(s) listed above to Charming Acres Rescue. It is understood that the surrendering party shall hold Charming Acres Rescue and all its officers, directors, employees, and volunteers harmless from any claims of damage, injury, or acts of negligence arising from this surrender. I have read and thoroughly understand this release of liability and agree to abide by it. Owner____________________________ Date____________