Willing Servants

Phone  *

Physical Address  *

Cell

City

State  *

Zip Code  *

County  *

Email Address  *

Do you Own or Rent your home?  *  Own   Rent 

How many years at your present address?  *

Landlords Address

Landlords City

Landlords State

Landlords Zip Code

Landlords County

Landlords Home Phone

Landlords Work Phone

Landlords Cell Phone

Landlords Email Address

May we contact your Landlord?  Yes   No 

All Applicants must be over the age of 18. Are you over the age of 18?  *  Yes   No 

Have you ever been charged with or convicted of animal abuse and/or neglect?  *  Yes   No 

If Yes, please explain

If Yes How Many?

Please list a little about each horse: Name, Breed, Age, uses, temperament

If Yes, how often?

If Yes, please provide the date your horses were last vaccinated

Types of vaccinations your equine(s) received

Please give us the date you last de-wormed your equine(s)

Which de-worming product did you use?

How often do you de-worm your horses?

Do you have a trailer and tow vehicle for safe transport of your fostered/adopted horse? YES / NO  *  Yes   No 

What is the year and size of your horse trailer?

Describe your experience with horses, handling, caring for horses, foaling, riding, training, showing  *

Briefly describe your equine facilities: size of barn, size of stalls, size of pastures, fencing materials used, type of watering system, special provisions made for winter, availability of safe hitching posts, Round Corral, quarantine facility, etc  *

Number of other equine that will be housed in the same pasture?  *

Can your foster horse be housed separately at first while being introduced?  *  Yes   No 

Briefly describe your equine management program. Number and times of feeding per day, feeding arrangements, i.e. separate tubs, group feeding, type of hay, preference of supplements.  *

Who will be feeding the adopted/fostered equine? Print Name  *

Farrier’s Name

Contact Number

How often do you plan to have a farrier trim and/or shoe the adopted/fostered equine?  *

Large Animal Vet’s Name

Large Animal Vets Address

Large Animal Vets Phone

Personal Reference #1: Name  *

Personal Reference #1: Address  *

Personal Reference #1: Phone  *

Personal Reference #1: Relationship  *

Personal Reference #1: Years Known  *

Personal Reference #2: Name  *

Personal Reference #2: Address  *

Personal Reference #2: Phone  *

Personal Reference #2: Relationship  *

Personal Reference #2: Years Known  *

If you do not own any equine(s), have you owned any in the past and if so how long did you own it for?

Within the last 5 years have you given away or sold any equine(s)?  *  Yes   No 

If Yes Please Explain

Within the last 5 years have any equine(s) died while in your care?  *  :Yes   No 

If Yes, please explain?

I have read the “Own Responsibility” handbook provided.  *  Yes   No 

I have considered the end of life choices and am prepared to deal with the cost and emotional responsibilities.  *  Yes   No 

Initials

What are you planning to use your adopted equine for?  *

How much time, per week, will you spend working with the adopted equine?  *

If the adopted equine can be ridden, how often do you plan to ride the equine each week, and for how long do you plan on riding?  *

Please list each person’s name, their age, height, weight and riding level (1=no experience to 10=very experienced) of every person that will be riding the adopted equine  *

*If, for ANY reason, you find yourself unable to care and provide for your adopted horse in the future, you agree to contact Willing Servants before pursuing alternative means of disposal of the horse. ______  *  Yes   No