Gray Dapple

Name of Adopters *


Street Address *


Home Phone *


Cell Phone *


Email *


Occupation/s


Combined Annual Income


Name of Horse/s interested in *


Brief description of experience with Horses *


Do You Currently have an equine vet? *
Yes No

Name and Phone number of vet if applicable


If boarding, Name and nuber of stable owner


Approximate number of horses at that location


Will this horse be kept in primarily: *
Stall Field With run in shed Other

Will horse recieve regular turnout
Yes No

Approximate Size of paddock/pasture


Stall is:
10x10 12x12 Larger

Type of fencing


Name and number of farrier


Name and number of equine dentist


Name and phone number of trainer (if applicable)


Please provide three personal references for contact and #'s *


Have you bred? Do You breed? Will you in the future?
Yes No Maybe

Do you plan to train and re-sell your adopted horse
Yes No

List all the horses you have owned in the last 15 years *


Which of these, if any, have you done with past horses? *
Sold
Traded
Sold to slaughter house
Sent to auction
Shot or had shot
None of the above

Please provide an explanantion of the circumstances