Thank you for your interest in adopting an Equine from Heartland Equine Rescue Inc. To ensure that each of our horses finds a permanent and loving home, our application asks several detailed questions that are necessary for the screening process. All information will be kept completely confidential. The Horse’s Welfare is our Foremost Concern We Reserve the Right to Refuse Adoption to Anyone.
Full Name: ____________________________________________ Age: _____________
Complete Address: _______________________________________________________
Home Phone Number: __________________________
Cell Phone Number: __________________________
Place of Employment: __________________________Occupation:_________________
Horse Ownership Information:
Do you currently own any horses? NO (__) | YES (__) (If yes please describe, if more than three, please include on back of page)
Horse 1: Breed: ___________________________________________ Age: _____ Sex: _________
Horse 2: Breed: ___________________________________________ Age: _____ Sex: _________
Horse 3: Breed: ___________________________________________ Age: _____ Sex: _________
If no, have you previously owned a horse(s)? NO (__) | YES (__) If you have previously owned a horse(s), indicate whether the horse(s) was sold, given away, or died (list age and cause of death.)
Do you have any animals other than horses? YES (__) | NO (__) ~ If yes, what kind?
Have you ever adopted a horse/animal from a rescue or animal protection agency? YES (__) | NO (__) ~ If yes, which one? Where is that horse/animal now?
Why are you interested in adopting a rescue horse?
Have you or any member of your family / household been accused, issued a warning / citation, or been convicted of any crime including animal cruelty, negligent care of animals or other humane violations? YES (__) | NO (__) If yes, please explain (Answering yes does not automatically disqualify you):
Have you ever sold a horse to auction? YES (__) | NO (__) If yes, please explain:
General Horse Care:
Who will be responsible for the care / feeding / training of this horse? _____________________________________
Who will be the primary handler / rider? ____________________________________________________________
Please describe past experience/history if any with horses (lessons, length of time, training, etc.): _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________
Briefly describe your training philosophy, what practice(s) do you employ when correcting negative behaviors?
_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________
Based off of the options below, what do you consider your level of expertise in caring/working with horses?
Beginner: New around horses, comfortable riding at a walk, little to no horse care knowledge
Advanced Beginner: Comfortable at walk and trot, limited knowledge, but can recognize signs of illness
Intermediate: Comfortable at all gaits, can handle horses that test rider, able to treat minor wounds.
Experienced: Comfortable handling difficult horses in various environments / situations.
Very Experienced: Previous experience training horses and / or in handling green horses.
That is the intended use for this horse?
Pleasure | Trail Riding | Lesson Program | Police Force | Fox Hunting | Racing | Steeplechase | Timber Racing | Eventing | Hunter | Jumper | 4-H | Pony Club | Roping | Barrels | Western Pleasure | Team Penning | Driving | Gaming Showing | Dressage | other: (describe): __________________________________________________
Are you applying for a specific horse? YES (__) | NO (__) ~ If yes, please provide that horse’s name:
If the specific horse you are applying for is not available or won’t meet your needs, would you consider another horse? YES (__) | NO (__)
Will you accept a horse with a limitation, but one still suitable for the intended purpose? YES (__) | NO (__)
Are you willing to adopt a horse that may have limitations on its use? YES (__) | NO (__)
For untrained horses: Are you planning to hire a trainer if you adopt a horse above your experience level? If yes, Name of Trainer ________________________ Phone number: ______________ Email: _____________________
If Currently a horse owner, please fill in the following:
How often do you vaccinate? ____________________________________________
Date of last vaccinations and type of vaccines given to horse(s): _____________________________________________________________________________________________
How often do you worm? _______________________________________________
Date of last worming for current horses and please describe your deworming program (type of dewormers used, how often, etc.): _____________________________________________________________________________________________
How often do you trim/shoe? ____________________________________________
Date of last farrier visit for current horse(s): _________________________________________________________
How often do you have your horses’ teeth floated? ____________________________________________________
Date of last dental float: ________________________________________________
Describe your feeding program (types of feed, hay, frequency and portions, etc.) __________________________________________________________________________________________________________________________________________________________________________________________
Facility or Boarding Information: (A site check will be performed prior to any adoption. Please fill out the next sections as thoroughly as possible. Please note we do require the facility to have adequate shelter and safe fencing in good repair.)
Will the horse be stabled on your property or boarded out? ________________________
If kept on your property:
Do you own the property where your horse will be living? YES (__) | NO (__) If yes, how long? _______________
Do you rent the property where your horse will be living? YES (__) | NO (__) If yes, please answer the following: How long have you been renting the property? ____________
Do you have permission from the landlord to keep horse? _______________________________________________
Landlord’s Name: ________________________________________ Phone: _______________________________
What is the number of acres the horse will be pastured on? ________________________
What is the total number of horses on this property? _____________________________
If this property is located at a different address than above, please give address.
What type of shelter do you have for the horse? ________________________________
If you have a barn, please give the number and size of stalls._______________________________
What type of fencing is used? _______________________________________________________
Where will the horse primarily be kept (pasture, stall, etc.)? _____________________________________________
If turnout is limited, how many hours of turnout a day will the horse receive? _______________________________
If the horse is to be boarded on someone else’s property:
Name of boarding stable: _________________________ Owner: _____________________________
Address of stable: _________________________________________________________
Phone Number: _________________________Fax Number: _______________________
Are you currently or have you previously boarded a horse at this facility? ______________________________
Will you be paying for full-care, partial-care, or self-care board? _________________________________________
Are you financially prepared to provide proper veterinary, farrier, emergency care, etc.? YES (__) | NO (__)
References: (It is Heartland's policy to call all references. This process can take several days depending on the availability of your references. If unable to provide a veterinarian or farrier reference please provide two additional personal/professional non-related references.) Please also provide pictures of your farm or boarding facility where horse will be kept.
Please list the name and phone number of a veterinarian that has been to the facility in which the equine will be kept. The vet office must have you or your boarding facility as being a current client. _____________________________________________________
Name: _____________________________________ Phone Number: _________________
Fax Number: ________________Address:______________________________________
Name: _____________________________________ Phone Number: __________________ Personal/Professional References (cannot be relatives)
1. Name/Phone Number/ Years known: ________________________________________________________
2. Name/Phone Number/ Years known: ________________________________________________________
3. Name/Phone Number/ Years known: ________________________________________________________
Heartland Equine Rescue Inc. retains the right to unilaterally seize the horse upon our determination that said horse is not being properly cared for, including neglect, physical abuse or mental abuse. If an adopted horse is found to have been abused or neglected, we will prosecute to the fullest extent of the law following our recovery of the horse and have the right to recover any legal fees if applicable. This is based on guidelines per Indiana State Law, or the County or City governing Laws in cooperation with Animal Control or Law Enforcement.
If for any reason you are unable to care for and need to return said horse, Heartland Equine Rescue Inc. requires the horse to come back to one of our facilities at your expense, and to be given at least a 5 day notice of such. No refunds will be given for either the adoption fee or any expenses incurred since adoption.
You may not breed, sell, give away, assign, dispose or transfer horse while in your care.
Heartland Equine Rescue Inc. reserves the right to conduct unannounced site inspections to check on the condition of the horse and the stable.
You agree to provide proper care and ongoing maintenance of the horse, to include, but not limited to year round shelter, free access to clean water, proper feed, inoculations, dental care, hoof care and worming. You are also responsible for providing veterinary care above and beyond in the event of illness, injury or accident.
By signing below, I agree to the conditions stated above and certify that the information on the application is true and correct to the best of my knowledge. I give Heartland Equine Rescue, Inc., its officers and agents’ permission to verify all the information contained therein.
Signature: ______________________________________________ Date: _______________________________
Please return the completed application:
By email: [email protected]