Name: _______________________________

Home Phone: _______________________

  Work Phone: _______________________

Address: _____________________________

City: _______________________               

State: _____                  Zip: _____________

Email Address:                                                                                                                   

Previous Address (if less than 3 years): _______________________________________________________________________

Employer: ________________________________________

Phone #________________

Annual Income:     Self: __________   Household: _____________

About You:

 Do You?       Rent             Own              Live w/ Parents:

Landlord’s Name: ___________________________

Landlord’s Phone #: ____________

Do you currently own a horse?  Yes:          No:

What is your price range for adopting a horse (what is your budget)?

From $______           to        $_______

Describe your experience with horses (riding/handling/training):

What do you plan to do with the horse you adopt from Mustang-Spirit?

You understand and agree that no horse adopted from Mustang-Spirit be used for breeding?   Yes:    Initial: __________

About the Horse you hope to adopt

Name of horse you wish to be considered for:                                                                     

If there is no particular horse that you have chosen, please give us as much information to help us find you the perfect match:

Do you prefer a certain horse or a certain type of horse?            Yes:           No:

What horse or type of horse would you like? _________________________________

Do you have specific height, weight, sex or performance requirements? What are they?

What are your riding skills (Beg., Int., Adv.)?                                                                         

Who will be the primary rider of the horse? ____________________________________

Would you consider a horse with special needs (please keep in mind that with rescuing horses comes a high chance that there could be emotional or physical problems, so consider this question carefully)?           Yes:            No:

List all type of limited needs that you are not willing to take:                                                                 

About where the horses will be kept

Will the horse be kept on your property?Yes: _____ No: _____

Describe where the horse will be kept (structure/shelter/other horses/security)

If the horse will be kept at a boarding facility, please tell us where the horse will be

Housed?

Name of Facility: ________________________________________________________________________

Address: ________________________________________________________________________

Phone #: _______________________

Contact Person: ___________________________

When will it be convenient to visit this facility? ___________________________

Who will feed the horse? ____________________

How often will it be fed? __________

Who will exercise the horse? _________________

How often? ________________

Describe your plans to care for horse during vacation: ________________________________________________________________________

Who is or will be your:

Veterinarian? _______________________

Phone #: _______________

Farrier? ____________________________

Phone #: _______________

Trainer? ___________________________

Phone #: _______________

How frequently do you think you should worm ________

trim hooves _________

float teeth _________ vaccinate ________

Please provide three references:

Name: _________________________________

Phone #: ____________________

Address: ______________________________________________________________

Name: _________________________________

Phone #: ____________________

Address: ______________________________________________________________

Name: _________________________________

Phone #: ____________________

Address: ______________________________________________________________

Have you ever been issued a warning or citation for humane violations? Yes       No  

If yes, please explain the disposition:

Other considerations or comments:

I certify that all the information contained herein is true and correct:

Signature: _________________________________________

Date: ______________

I certify that I am over 18 years of age:                      (initial)

Signature: _________________________________________

Date: ______________

I certify that I am over 18 years of age:                      (initial)

Mustang-Spirit

PO Box 290640

Phelan, CA  92329

(888) 532-4524

Office Use Only:   Application Approved:                                                                                                            Site Check Done:                         Date:                      Mustang-Spirit Representative Initial:

 

*Note, by signing this contract, you are releasing Mustang-Spirit and it’s foster home volunteers from liability for any injury or loss when on their property.  Horses are animals and injury can occur when handling, riding and working with these animals.  This release of liability will be in effect for signer and family when applicable.  This will remain in effect until signer gives written notice.  Each individual not related to signer should complete a separate release form.