| Full Name: * |
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| E-mail Address: * |
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| Phone Number: * |
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| Street 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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| Married/Single: * |
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| Do you have children? Ages? 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(s) 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 have had a horse(s) before are/were 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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| What type of shelter/pasture/fence will you provide for your horse? How many acres would this horse be on?: * |
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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? 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 and Permission: By typing your full name 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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| Date: * |
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