Adoption Application for Horses – Southern Star Animal Rescue, Inc.

EQUINE ADOPTION APPLICATION

APPLICANTS MUST BE 18 YEARS OF AGE OR OLDER.
Applications by minors musty be submitted by a parent or legal guardian.)

Please check one

First Name *

Last Name *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Home Phone Number

Work Phone Number

Cell Phone Number

Email Address *

Date of Birth

Current EmployerEmployer's Address

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Years Employed by Current Employer

Do you own or rent your home?

OwnRent

If renting, full name and address of landlord:

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Year(s) Lived at Current Address

Have you previously owned a horse?

YesNo

If yes, how long ago (in years)?

Do you currently own a horse?

YesNo

If yes, for how many years?

How many other horses do you have now?

Will the horse be stabled on your property?

YesNo

Name of 1st reference

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone number of 1st reference

Name of 2nd reference

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone number of 2nd reference

Name of 3rd reference

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone number of 3rd reference

Veterinarians Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Veterinarians phone number