Adoption Application

Names:  __________________________________________________________________________________

Email Adresses:  ____________________________________________________________________________

Address:  __________________________________  City, State, Zip  _________________________________

Home Phone:  _______________________________  Work Phone:  __________________________________

If residing here less than one year, please provide previous addresses and length of time living there.

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Are you over the age of 18?    Yes    No

Are you interested in: Adopting_________ or Fostering________ or Both_________

Employer Name:  ______________________________  Employer Phone: ______________________________

Employer Address:  ____________________________  City, State, Zip:  ______________________________

Length of time employed:  _______________________

Do you currently own a horse?    Yes    No                How many?  __________________________________

Description of horse(s):  _____________________________________________________________________
                                   
                                    _____________________________________________________________________

                                    _____________________________________________________________________

If you have previously owned horses, please describe the circumstances that led to dissolving ownership.

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Briefly describe your experience in the following areas:

Riding:  ___________________________________________________________________________________

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Training:  _________________________________________________________________________________

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Handling/Grooming:  ________________________________________________________________________

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Nutrition:  _________________________________________________________________________________

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Young or unbroken horses:  __________________________________________________________________

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Aging or senior horses:  _____________________________________________________________________

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Special medical needs horses:  ________________________________________________________________

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Have you ever had a horse die while under your ownership?    Yes    No

If so, please explain the circumstances:  ________________________________________________________

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Is there a specific CCFER horse that you are interested in?    Yes    No

If so, please provide the name and breed as listed on the website.  ____________________________________

Who will be riding/handling the horse?  _________________________________________________________

How much time per week do you plan on spending with the horse?  __________________________________

What is the intended use of this horse?  _________________________________________________________

If rideable, how often do you plan to ride per week?  ______________________________________________

Will the horse be kept on your property?    Yes    No

If yes, who will be responsible for feeding the horse?  _____________________________________________

If no, where will the horse be kept?

    Property/Facility owner:  ___________________________________________________________________

    Address:  _______________________________________________________________________________

    Phone number:  __________________________________________________________________________

Is this...    A professional stable        A private facility  ?

Will the horse be kept in a pasture orin a barn?  ___________________________________________________

If pastured, how large is the pasture and how many horses will be sharing the pasture, if any?  ____________

If pastured, what type of fencing encloses the pasture?  ____________________________________________

If stalled, how large are the stalls?  _____________________________________________________________

If stalled, how often will your horse be turned out?  _______________________________________________

Please indicated how much you anticipate spending yearly for the following:
    Feed / Boarding:  ____________________

    Veterinary Care:  ____________________

    Farrier Care:  ____________________

    Worming:  ____________________

If you own animals now, please descrive type, name, age and how acquired.

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Intended Veterinarian for your horse:  ___________________________________________________________

Practice / Clinic name:  _________________________  Phone:  ______________________________________

Intended farrier for your horse:  _______________________________________________________________

                                                                               Phone:  ______________________________________

Other animal care professional:  _______________________________________________________________

    Field of care:  _____________________________   Phone:  ______________________________________

Have you ever been issued a citation or been found guilty of any humane violation?    Yes    No

    If yes, please explain:  _____________________________________________________________________

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Please indicate when it would be convienient for Clear Creek Equine Rescue to conduct an inspection on the

inteded property or barn:  ____________________________________________________________________



Please provide three references:

   Personal reference 1:
       
        Name:  __________________________________

        Address:  ________________________________

        Phone:  __________________________________

        Years known:  ____________________________

    Personal reference 2:

        Name:  __________________________________
  
        Address:  ________________________________
 
        Phone:  __________________________________

        Years known:  ____________________________

   Veterinarian Reference 1:

        Name:  __________________________________
 
        Address:  ________________________________

        Phone:  __________________________________

        Years known:  ____________________________

Sign:_________________________________________________________________

Date:_______________________________________

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