Adoption Application

Adoption Application/ Print, Fill & Mail.

There must be an interview, a inspection of where the horse is to live & completion of the application before approval. There is a strict adoption contract that must be agreed to and signed before adoption process is complete.

Healing Horses “One child at a time” Inc.

28821 Bennington Drive

Wesley Chapel, Florida 33544

(813) 900-6305

ADOPTION APPLICATION

Healing Horses “One child at a time” Inc., requires ALL applications be submitted with photographs of the pastures, fencing, barn and stalls, and any other horses/ponies at the facility where the horse/pony will be kept. Healing Horses “One child at a time” Inc., may request additional information or pictures to complete its review and may require a visit to your facility before your application will be approved.

General Information

Full Name:________________________________ Age: _______ Driver’s License number with

State or State ID number: __________________________________________________

Address: ____________________________________________________________________

Town: ____________________________, State: ________ Zip Code: _________

County: ______________ Telephone Number (with area code): ____________________Cell number (with area code):_______________________

Email Address: _________________________________________________

Work Telephone Number: ___________________ Occupation:_______________________

Full Name: _____________________________Age: _______ Driver’s License number with State or State ID number: __________________________________________________

Address: ____________________________________________________________________

Town: ____________________________, State: ________ Zip Code: _________

County: ______________ Telephone Number (with area code): ____________________Cell number (with area code):_______________________

Email Address: _________________________________________________

Work Telephone Number: ___________________ Occupation:_______________________

Will you agree to Healing Horses “One child at a time” Inc., requirements that a Veterinarian Certification and picture of the adopted horse/pony be submitted to Healing Horses “One child at a time” Inc., every six (6) months? Yes:___________initials No: _____________initials

Will you agree to Healing Horses “One child at a time” Inc., requirements of adoption to include no breeding of mares?

Yes:________________initials No:______________intitials.

Will you agree to Healing Horses “One child at a time” Inc., requirements that as the adopter, you will have a legal and contractual obligation to return the adopted horse to us if at any time you can no longer provide shelter, feed, medical care, blacksmith care or adequate care for the adopted horse?

Yes:_______________ initials No:____________________initials

Will you agree to Healing Horses “One child at a time” Inc., requirements that as the adopter, you will have a legal and contractual obligation to inform us if you intend to sell the horse adopted & named in this application and the transfer of this animal can’t take place without our approval of the potential new owner and their signing the same agreement?

Yes:__________________________ Initials No:____________________ Initials

Will you agree to Healing Horses “One child at a time” Inc. periodically doing visit checks on the adopted horse in your possession?

Yes:_______________initials No:____________________initials

Questions

1. If there is a specific horse or pony you are interested in, please state the name of that horse or pony.

2. Please list the name, address, and telephone number of your current veterinarian and farrier that will be caring for your horse or pony?

A. Veterinarian = ____________________________________________________

____________________________________________________

B. Farrier = ____________________________________________________

____________________________________________________

Please list three personal references that are not family: Print Please

Name____________________________ Phone________________Address_____________________

3. What is your experience with horses? ________________________________________

______________________________________________________________________

4. What is the intended use for this horse or pony? Please place an "X" next to all possible answers:

______ Companion (no riding) ______ Pleasure riding only ______ Trail riding

______ Jumping ______ Barrels, Poles, etc. ______ Endurance riding ______ Dressage

5. Will the horse be stabled on your own property? _________

If you answered yes to this question, please answer the following

questions "a" through "c".

a. If your own property, how many acres do you own? ________

b. How many pasture acres will the horse/pony have? _________

c. How many horses and/or ponies do you currently have? _________

d. Have you sold any horses or ponies in the past five (5) years? _________

a. If yes, what were the reason(s) for selling: __________________

____________________________________________________

6. If the horse/pony will be stabled at a boarding facility (or on someone else’s farm or property), please provide the following information:

a. Name of the boarding facility (or farm)____________________________________

b. Owner’s name of the boarding facility or farm: _____________________________

c. Address of the boarding facility or farm:___________________________________

___________________________________________________________________

d. Telephone number of the boarding facility: _________________________________

e. Total number of horses/ponies at this facility: _______________________________

7. Whether on your property or at a separate facility, please answer the following questions:

a. What type of shelter (i.e., barn, run-in shelter, etc.) will the horse/pony have? _______ _____________________________________________________________________

b. If a barn, please provide the number of stalls and the size of the stalls. _____________

_____________________________________________________________________

c. What type of fencing is used for the horse pasture? ____________________________

8. Please list the names, addresses, and telephone numbers of two references familiar with your experience and care of horses that we may contact.

1. ____________________________________________________________________

____________________________________________________________________

2. ____________________________________________________________________

____________________________________________________________________

Applicants signature:__________________________ Date:__________________________

Applicants signature:_________________________ _Date:__________________________

Adoption fees: Fees must be paid by money order, certified check or cash. NO personal checks accepted.

When completed, please return to: Healing Horses “One child at a time” Inc. 28821 Bennington Drive, Wesley Chapel, Florida 33544 (813) 900-6305

501 (c) 3 Non for Profit