Equine Information Form

EQUINE INFORMATION FORM - CURRENT OWNER

To assist Sundance Horse Rescue, Inc. (SHR), in rehoming your equine you will need to fill out this form
completely and sign the agreement at the bottom. Upon surrender or placement in a new home, we do request
a monetary donation, (amount to be discussed and agreed upon), to help offset the ongoing expenses for our
rehoming program and helping the horses currently at the rescue. Please gather all documentation (photos,
videos, registry papers, any other medical information, etc.) when your equine is delivered or picked up.

I, the undersigned, do hereby provide this information to the best of my knowledge.

EQUINE INFORMATON

Equine Nickname *

Full Registered Name *

Registration Association *

Registration Number *

Breed *

Age *

Gender *

Hands High *

Color *

Descriptive markings, brands or tattoos, chip, other:

Address of where the horse is currently located:

Please list all known special needs, overall temperament, any likes/dislikes, quirks, vices, and any other
necessary or useful information. This information will help us with the rehabilitation process, if needed, and
helps keep our staff safe.

CURRENT OWNER INFORMATION

Full Name *

Cell Phone *

Home Phone *

Address *

City *

State *

Zip *

Email Address *

Drivers License State *

License # *

MEDICAL INFORMATION

Veterinarian *

Last Seen On: *

Farrier *

Last Seen On: *

Dentist *

Last Seen On: *

Date of last Vaccination/Treatment

E&W Encephalomyelitis *

Tetanus *

Rhino‐Flu *

Rabies *

West Nile Virus *

***Attach the most recent vaccination records to this form.

Upload Vaccination Record *

Max file size: 20MB

Are there any medical conditions we should be aware of? (e.g. founder, cushions, EPM, feed or medication
allergies, etc.) If yes please explain:

When was equine last wormed? *

What type of wormer used? *

Known injuries, lameness or other medical conditions? Y/N
(please attach veterinary or other heath provider documentation)

*	* Max file size: 20MB

Current treatment or veterinarian recommendations:

Please list any previous or current health issues or special needs:

ADDITIONAL INFORMATION

How long have you owned this equine? *

Has equine been kept in stall, pasture, etc.? *

How does this equine get along with others in a herd situation? *

Is your equine accustomed to being around other animals such as cows, dogs, cats, etc.? *

Has this equine ever injured anyone? If yes please explain:

Does this equine stand tied? *

Does this equine lead? *

Does this equine stand to be bathed and groomed? *

Does this equine stand to be wormed/vaccinated? *

Does this equine stand easily for the farrier? *

Does this equine trailer load easily? *

Any habits we need to be aware of? (e.g. bites, kicks, rears, bucks, cribs, etc) If yes, please explain: *

Has this equine ever received professional training?

What type of training and for how long? *

Has equine been trained to ride? What disciplines? If yes, in what situations has this equine been ridden? *

When and where was the last time the equine was ridden? *

Has equine been trained to drive? *

List any bad habits under saddle or in cart; bad ground manners; bad habits in stall: *

Do you have any tack, grooming supplies, etc. to donate with your equine? If yes, please list:

Is there a firm deadline on placing this horse before euthanasia?

DATE: *

Please write up a history of this equine. We can’t promise specifics when placing equines into new homes; however, we do try to take into account the type of situations owners would like to see their equine go to. Please provide as many photos and videos as possible. These are great tools for rehoming.

REPRESENTATIONS AND WARRANTIES

I hereby represent and warrant to SHR, that the undersigned is: (a)the sole owner of the above described
equine; (b) has the authority to surrender this equine for adoption/placement or retirement through SHR; (c)
that no other person or person’s signature is required to initiate a valid transfer of ownership and registration
papers on this equine (if available); (4) and that no other person or persons has a lien, claim, title or any legal
equitable ownership interest in this equine. I agree to deliver to SHR a properly signed transfer of all
registration papers, if available, for the above described equine, omitting the name of the transferee.

* Indicates required field

Initials: *

I also agree to provide SHR with all available information concerning this equine which might assist with finding
the equine a future home. This information includes, but not limited to, health/vaccination records, previous
owners’ identification, life events, and individual personality traits. I also understand SHR may contact previous
owners, breeders, veterinarians, and farriers to obtain information to assist in placing the above referenced
equine in a suitable home.

Initials *

This document is not a guarantee of placement for your equine. It is solely informational to assist us in possibly
placing your equine in an appropriate and loving forever home.

Initials *

I UNDERSTAND that by typing my name exactly as it appears below, it signifies that I am completing this form using an electronic signature and will serve as electronic representation of my signature, just the same as a pen-and-paper signature. By signing electronically, I am certifying that the information I have given is true and complete. I authorize investigation of all statements on this application. I understand that this application is property of the SHR.

I have read the preceding and agree to all conditions set forth.

Signature: *

Date: *

Submit

​EQUINE INFORMATION FORM - CURRENT OWNER

EQUINE INFORMATION FORM - CURRENT OWNER