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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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Do you rent or own? If renting, name and number of your landlord:
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Have you discussed adopting a horse with your landlord and been approved to have a horse? (If this does not apply to you, put does not apply. This would ONLY not apply if you OWN your house.):
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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) your 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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