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 [email protected]
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:
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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.
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Medical and Temperament History:
Most recent vaccinations including date administered:
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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?
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Known unsoundness, lameness, or other medical conditions: (please attach any veterinary or other health provider
documentation)
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Current treatment or veterinarian recommendations:
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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.
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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____________