Surrender Agreement

EQUINE SURRENDER AGREEMENT

Thank you for entrusting Sundance Horse Rescue, Inc. (SHR) with your equine to ensure it is placed in a new
forever home. To surrender your equine to SHR, you will need to fill out this form completely and sign the
agreement at the bottom. Please forward all documentation (registry papers, any other medical information,
etc.) before the equine is transferred. We kindly request a monetary donation to help offset the ongoing
expenses to support our mission of rescuing horses that are starving, abused, neglected and in need of rehab,
training and rehoming. Please help us help your horse and more horses in the future.

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 surrender 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 at 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 *

I further understand that all future decisions regarding the placement of this equine will solely be those of SHR. I also
understand if this equine is found to be unsuitable for placement for reasons determined by SHR and/or a licensed
veterinarian, that the equine may either be retired at SHR or euthanized.

Initials *

By executing this document, I agree to forever surrender legal ownership and relinquish, transfer, convey and assign any
and all rights, titles, claims and interests, regardless of the delivery or non‐delivery of registration papers to SHR, of this
equine voluntarily and without coercion or threats of any kind. It is understood that the surrendering party shall hold
SHR, its owners, officers, board of directors and/or agents, employees, and volunteers harmless from any and all actions,
debts, dues, claims and/or damages, injuries or acts of negligence arising from this surrender or relating to the transfer
of ownership of the above listed equine.

Initials *

This is a legally binding document for the irrevocable surrender of an equine for placement in an adoptive home by
SHR. Please read this document carefully and thoroughly before signing.

I, the undersigned, have read the preceding and agree to all conditions set forth. I do hereby irrevocably surrender and
relinquish to Sundance Horse Rescue, Inc. for placement, adoption, or retirement, the above equine:

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.

Signature: *

Date: *

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The acceptance of this Surrender Agreement requires the signature of a SHR Board Member. Board member signatures
may be obtained via written correspondence accepting above referenced Equine and attached to this agreement.

Submit