ADOPTION APPLICATION

JENNY AND DAVE’S 2^ND CHANCE RESCUE RANCH APPLICATION

(AKA- J & D)

If you are interested in adopting one of our horses, please fill out the application below. Please fill out the application and then print it out with a $5.00 application fee. We will process your application and then notify you whether or not you will be approved. We reserve the right to adopt or not adopt to anyone we feel is not right for one of our rescue horses. We will also require a vetinarian and personal reference before you will be considered for adoption. Please include letters along with your application or we can call on references. Based on the condition of each individual horse, our fees will often be between $300-$1100. 100% of the adoption fees go right back into the rescue for vet bills, feed and buying more horses. I am sorry, but we cannot give refunds. We also ask that any mares that we may adopt NOT be impregnated. We are trying to place the horses that are here, not to add to the population. All males will be gelded or gelded later if they are too young at the time of adoption. HORSES ARE NEVER TO BE SOLD AT ANY AUCTION -- EVER!

Application

Your Full Name: ______________________________________________________________

Email: _______________________________________________________________________

Your Parents’ Names (if under 18 years of age): ____________________________________

Address: _____________________________________________________________________

City & State: _________________________________________________________________

Zip Code: ____________________________________________________________________

Home Phone: _________________________________________________________________

Work Phone: _________________________________________________________________

Cell Phone: ___________________________________________________________________

Driver’s License Number and State Issued: ________________________________________

Social Security Number: ________________________________________________________

Horse Preferences (please circle)

Gender:

Gelding Mare Stud No Preference

Age Preference:

No Yes If yes, please specify _________________

Color Preference:

No Yes If yes, please specify _________________

Breed Preference:

No Yes If yes, please specify _________________

Size:

14-15 Hands 15-16 Hands 16+ Hands No Preference

What would you use your horse for primarily?

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Please tell us of your horse experience in riding.

Are you at a?

Beginner rider Experienced rider

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Would you be able to train your horse or would you hire a trainer? ____________________

Please tell us how you feel about horses and your previous experiences with horses? (Use a separate page if necessary)

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Have you ever had a horse before or been responsible for a horse before or now? Do have a horse now? Please describe horses you have now.

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Where will this adopted horse be boarded? (If at a boarding faculty, give information)

Name: _______________________________________________________________________

Address: _____________________________________________________________________

Phone: _______________________________________________________________________

Who will be responsible for the daily care of this horse?

______________________________________________________________________________________

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What kind of shelter will this horse have?

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Will the horse have a turnout area? What size of turnout?

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What kind of fencing around the turnout area?

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What kind and how much grain will be provided per day?

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What kind and how much hay will be provided per day?

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What access will be provided for water?

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(If possible, please provide us with pictures of your farm, shelter and turnout area. We have the right to visit the facility before adopting a horse to you.)

REFERENCES

Veterinarian (if you do not currently own a horse, please list the small animal vet you use.)

Name: _________________________________________________________________

Address: _______________________________________________________________

Phone: __________________________________________________________________

How long have you worked with this vet?

______________________________________________________________________________

Farrier (if you do not currently own a horse, please list a farrier you have contacted in your area.)

Name: _________________________________________________________________

Address: _______________________________________________________________

Phone: _________________________________________________________________

How long have you used this farrier? _____________________________________________

Personal References (do not use relatives)

Name: _________________________________________________________________

Address: _______________________________________________________________

Phone: _________________________________________________________________

How long have you known this person? And how do you know them?

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Name __________________________________________________________________ Address: Phone: __________________________________________________________________

How long have you known this person? And how do you know them?

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PLEASE SIGN BELOW TO VERIFY THAT ALL OF THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUTHFUL AND ACCURATE. THIS ALSO SERVES AS AUTHORIZATION TO J & D 2^ND CHANCE RESCUE HORSE RANCE TO OBTAIN INFORMATION FROM ALL REFERRAL TO PROCESS THIS APPLICATION.

Applicant Signature: ______________________________________________________________________________

Date: ________________________________________________________________________

Parent or Guardian Signature (if under 18 years of age) ______________________________________________________________________________

Date: ________________________________________________________________________

Placement Contract

Please read carefully and sign where specified. The adopter agrees to the following stipulations and conditions concerning each adoption through J & D 2^nd Chance Horse Rescue Ranch. No breeding should ever be allowed

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OWNERSHIP: Once adopted, a horse remains the property of J & D 2^nd Chance Horse Rescue Ranch for 5 years. It may ONLY be transferred back to said program with the first 5 years after adoption. The horse may not ever be sold, given away, disposed of, or transferred to anyone but J & D 2^nd Chance Horse Rescue Ranch within the first 5 years after adoption.
TRANSPORTATION: Once an adoption fee has been paid in full, transportation costs to adoptive home or back to J & D 2^nd Chance Horse Rescue Ranch during the time frame of the adoption remain the full responsibility of the adopter.
BOARDING/STABLING: The adopter agrees that the named horse will reside at this address:

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(Please give directions on the reverse side of this page.) If stabling is relocated, J & D must be notified and give approval prior to moving the horse. J & D may not be held liable for delinquent board bills. If the adopter defaults on board payments past 30 days, J & D reserves the right to obtain the horse from the boarding property.

RETURN POLICY: There are no monetary refunds on horses, and the adopter understands that any horse coming back into J & D care will not justify a refund. If a horse is returned to the program within 30 days after placement, the adopter will receive credit for the adoption fee pain, which may be put toward the adoption of another horse only (no credit after this exchange period).
BASIC NEEDS REQUIREMENTS: The basic needs of the horse must be met, including proper feeding to maintain appropriate weight, free access to water, a minimum three-sided shelter, and adequate fencing. The horse must maintain weight and condition as advised by a licensed veterinarian.
HEALTH CARE: Inoculations should be administered by licensed vet for the first full year after adoption. If you choose to vaccinate your own horse after this time, please state which vaccinations you will administer and how often. The following veterinary care is strongly recommended:
1. WORMING AND HOOF CARE: Worming should be done every eight (8) weeks. Hoof care should be done every six to eight (6-8) weeks.
2. SPRING INOCULATION (April 1): Eastern/Western Encephalitis, Tetanus, Rabies, Dental Care, and any other inoculation your vet recommends for endemic diseases. West Nile vaccination is strongly recommended!
3. FALL INOCULATION (October 1): Flu, Rhino, Dental Care, and any other inoculations your vet recommends for endemic diseases.
SPRING VET CHECK: The adopter agrees to forward a vet’s brief statement of the horse’s residence, condition, weight, teeth and hoof condition at the time of spring inoculations OR upon request. (A health check card may be sent to you by J & D for this purpose).
INJURY OR ILLNESS: Horses can experience injuries or illness while in an adopter’s care. Adopter understands and agrees that any injury or illness will be identified and treated while in placement, and if a horse is returned to J & D program after an injury or illness, the adopter agrees to pay all veterinary costs related to assisting the horse to a full recovery. The adopter agrees to provide recommended vet care for illness and/or injury according to the horse’s needs and/or according to the requirements of ______________ County ordinance and/or State of ____________________ law.
LIFE-THREATENING SITUATIONS: Should a life-threatening situation arise, J & D must be notified immediately and prior to any thought of euthanization. The following require notifying J & D within 24 hours:
1. SERIOUS INJURY OR ILLNESS that could be life threatening.
2. DEATH OF A HORSE. A statement from a vet stating the apparent cause of death must be forwarded. Euthanization is not your option. J & D reserves the right to approve of or deny recommendation to euthanize a horse.
CONDITION, TEMPERMENT, AND SOUNDNESS: Horses placed by J & D include no guarantees pertaining to general condition, temperament, or soundness.
LIABILITY: The adopter agrees to hold harmless any employees, volunteers, or former owners of a horse for any damage or injury received by any person or property by an adopted horse. If legal action is taken, the adopter agrees to pay all horse-related property damage, personal injuries and third party claims.

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IF THE ADOPTER FAILS TO COMPLY WITH ANY OF THE CONDITIONS OR STIPULATIONS SET HERE, J & D RESEARVES THE RIGHT TO REGAIN POSSESSION OF THE HORSE. THE ADOPTER AGREES TO PERMIT A REPRESENTATIVE OF J & D TO VISIT THE STABLING PROPERTY AND THE HORSE WITH PRIOR NOTICE. THE ADOPTER ALSO AGREES TO ALLOW J & D TO RETURN A HORSE TO THE PROGRAM IF THE WELL BEING OF THE HORSE IS DETERMINED BY J & D REPRESENTATIVES TO BE THREATENED.

J & D WOULD APPRECIATE THE FIRST CHANCE TO BUY OR ADOPT THE HORSE IF ADOPTER SELLS THIS HORSE AFTER THE 5 YEAR ADOPTION AGREEMENT.

BY SIGNING THE BELOW, I CERTIFY THAT I HAVE READ AND ACCEPT THE TERMS, CONDITIONS, AND STIPULATIONS THAT PERTAIN TO THE ADOPTION AND PLACEMENT OF A HORSE FROM J & D. I UNDERSTAND THAT THESE TERMS, CONDITIONS, AND STIPULATIONS APPLY TO THE HORSE (OR HORSES) THAT WILL BE LISTED IN THIS FORM AT THE TIME OF PLACEMENT. A COPY OF THIS AGREEMENT WILL BE SENT TO YOU AFTER AN ADOPTION HAS TAKEN PLACE.

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APPLICANT SIGNATURE: _________________________________________________

DATE: ___________________________________________________________________

PARENT OR GUARDIAN SIGNATURE (IF UNDER 18 YEARS OF AGE)

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DATE: ___________________________________________________________________

HORSE INFORMATION

To be completed at time of placement

DATE OF PLACEMENT: ___________________________________________________

HORSE NAME: ___________________________________________________________

AGE: _____________________________________________________________________

SEX: _____________________________________________________________________

ADOPTION FEE: __________________________________________________________

PAYMENT METHOD: _____________________________________________________

TATTOO NUMBER: _______________________________________________________

SPECIAL TERMS AND CONDITIONS, IF ANY:

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I ACCEPT THIS HORSE UNDER MY CARE “AS IS” AND AGREE TO THE TERMS AND CONDITIONS OF THE PLACEMENT CONTRACT AS WELL AS ANY LISTED ABOVE. SHOULD I NEED TO RETURN THIS HORSE TO THE PROGRAM WITHIN THE NEXT 14 DAYS, I UNDERSTAND I WILL RECEIVE CREDIT FOR THE ADOPTION FEE I HAVE PAID, WHICH MAY BE PUT TOWARD THE ADOPTION OF ANOTHER HORSE ONLY (NO CREIDT AFTER THIS EXCHANGE PERIOD). I REALIZE ADOPTION FEES HELP DEFRAY THE COSTS OF ADOPTION SERVICES (e.g. BOARDING, TRANSPORATION, TRAINING, PLACEMENT, ETC.) AND DO NOT CONSTITUE PURCHASE OF THE HORSE BUT RATHER ADOPTION WITH ALL ITS PRIVILEGES AND RESPONSIBILITIES. (please initial here) ______________________________________

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ADOPTER’S FULL NAME (please print) ______________________________________

ADOPTER’S SIGNATURE: _________________________________________________

DATE: ____________________________________________________________________

PARENT OR GUARDIAN SIGNATURE

(if under 18 yrs of age) ______________________________________________________

DATE: ___________________________________________________________________

AUTHORIZED J & D REPRESENTATIVE SIGNATURE_______________________________________________________________

DATE: ___________________________________________________________________