First Name (required)

Last Name (required)

Mailing Address (required)

Street Address (required)

City (required)

State (required)

Zip (required)

Home Phone (required)

Cell Phone (required)

Work Phone (required)

Your Email (required)

Website (if any)

Age (years) (required)

Occupation (required)

Gender (required)

Do you have children (required)

Yearly Income

Are you interested in an equine that we have up for adoption now? (required)

If yes, which equine are you interested in?

What rider level are you? Beginner, Intermediate or Advance?

Why do you want to adopt our equine?

Will this be your first equine?

Do you currently have other equines?

How many equines have you owned in the last year?

Are you going to be the sole caregiver for the adopted equine?

If no, who will be helping you?

What is your price range you are willing to pay for a rescued equine?

What training level of equine are you looking for?

Would you adopt an equine with special needs?

Will the equine be kept at your home?

Do you rent your land?

If yes, has your landlord give the "OK" to keep equines on the land?

How many acres of land do you rent or own?

What type of fencing to you have on your land?

Do you have a stall or shelter?

Do you have a barn?

Will the equine be kept a boarding stable or other?

If yes, please give us a description of the facility:

Please provide name of facility and contact information:

Please provide at least one personal references including first and last name, phone, email::

Please provide the name, address and phone number of your Veterinarian:

Will you provide health-care in a timely manner?

Will you return your equine to Horses Healing Hearts, Inc. if you can no longer care for it or if you are unable to find a loving home for it?

Will you allow a Horses Healing Hearts, Inc. representative to visit your home?

Please provide any other information you feel would be important for us:

Would you like to receive our E-Newsletter and be updated on upcoming adoption opportunities?

How did you hear about us?

To complete this form, please provide your electronic signature by typing your full name in the box, then submit the form. We will contact you shortly. Thank you:

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