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Full Name:
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Phone Number:
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E-mail Address:
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Home Address:
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City:
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State:
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Zip Code:
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Date of Birth:
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Occupation:
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Work Phone:
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Employer:
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Marital Status:
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Do you have any Children:
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If you have children, how many and what ages are they? Do they have experience with horses?:
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Are there any other individuals living in the same household? Names and ages:
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Does anyone have allergies or asthma that would be aggravated by a horse?:
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Have you ever owned a horse before? What kind?:
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What happened to your previous
horse(s):
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Do you have a way to pick the horse up and take it home if you are approved to adopt?:
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If you currently own any horses, are they current on their vaccinations /coggins /worming? If not, why?:
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If you own a male horse is he gelded? If not, why?:
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Name and phone number of your past or present veterinarian:
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typing your name and phone number in the box to the right you are
agreeing to have all of your pets veterinary records released to Lost
But Loved (L.B.L.) Animal Rescue either by phone, fax, or e-mail so
that we can process your adoption application.
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What type of shelter/pasture/fence will you provide for your horse? How many acres would this horse be on?:
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| Do you travel or go out of town a lot? If so how do you provide care for your horse will you are away?: |
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Have you discussed adopting a horse with your family? Is everyone in agreement about adopting?:
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What would you do with this horse if you could no longer care for him/her?:
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Name of Horse(s) you are interested in:
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| Have you ever been charged with cruelty to animals or been in jail before? If so please explain: |
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| Would you be OK with LBL Animal Rescue running a background check to make sure that all of the above information given is correct?: |
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Signature:
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Date:
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