Surrender Application Form for Horses - Southern Star Animal Rescue, Inc.

SURRENDER APPLICATION FORM

PLEASE NOTE THAT BY FILLING OUT THIS FORM IT DOES NOT MEAN THAT WE WILL ACCEPT THIS HORSE, DONKEY OR MULE. THIS IS STRICTLY FOR SSARI TO REVIEW AND MAKE DETERMINATION. THE SURRENDER FEE IS $200 UNLESS WE HAVE DISCUSSED DIFFERENTLY. THIS HELPS US WITH THEIR VET INTAKE EXAM. IF YOU HAVE ANY QUESTIONS OR CONCERNS, PLEASE CONTACT US DIRECTLY TO DISCUSS FURTHER.

Name of Horse *

Breed

Age *

Sex *

Height *

Weight *

Color *

Markings

Reason for Return or Surrender *

0 / 600

Date of last trim

Month

Day

Year

Date last Shod (if applicable)

Month

Day

Year

Date of last worming

Month

Day

Year

Type of wormer used

Date of last vaccinations

Month

Day

Year

Type of vaccinations

Date of Coggins

Month

Day

Year

Date equine’s teeth were floated

Month

Day

Year

Any health issues in the past? Colic episodes, surgeries, illness, malnutrition, vaccine reactions, etc

What Veterinarian have you used for this horse

Vets Phone Number

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Any Past lameness issues, injuries, or accidents: Abscesses, tendon strain, fall, flip, head injury, etc

Does this horse currently have any health issues and on any medications?

Any behavioral problems or vices: Cribbing, wood chewing, etc

What does your horse enjoy doing?

Daily Feed *

Amount of Feed *

Hay *

Amount of Hay *

Daily Supplements

Turn-out Schedule

How Long?

Which of the following is your horse in?DirtGrassPaddock

How is the horse around other horses?

Is he/she currently turned out with others?

Hoof care (Please pick one)BarefootShodSpecial Shoeing

Frequency of Hoof care

If your horse requires special shoes, please explain: for what condition, the type of shoe(s) and when the corrective shoeing began

Is there any additional information that you would like us to know regarding the horse and/or situation?