Fill and Sign the Donation Contract Form

Equine Donation Contract Donor Contact Information : Name: __________________________________________________________ Address: _________________________________________________________ City, State, Zip ____________________________________________________ Home phone: ___________________ Work Phone: ______________________ Email address: ____________________________________________________ Name of your veterinarian: ___________________________________________ Veterinarian’s phone number: ________________________________________ May we allow potential adopters of the equine you are donating to contact you? [ ] Yes [ ] No Will you act as a reference so that others wishing to donate equines may contact you to ask questions about your dealings with _____________________________ (Name of Organization) ? [ ] Yes [ ] No Equine Information Name of equine you are donating: ________________________________ Breed of equine you are donating: _______________________________ Is the equine registered? If so, with what registry? ___________________ Registration number? __________________________________________ Color of equine: ______________________________________________ Markings on equine: ___________________________________________ Age: ________ Height: ________ Weight: ________ Gender: ________ Name of Dam (if known): _______________________________________ Name of Sire (if known): ________________________________________ Is the equine micro-chipped? [ ] Yes [ ] No If so, whose name is the microchip information in? ____________________________ Is the equine branded? [ ] Yes [ ] No If so, where and what is the brand? ________________________________________ Does the equine have a lip tattoo? [ ] Yes [ ] No If so, what is the tattoo? _________________________________________________ Temperament (1-10, 1 = Very Quiet, 10 = Highly Spirited): ______________ Friendliness towards adults (1-10, 1 = Nasty or Afraid, 10 = extremely friendly):_____ Friendliness towards children (1-10, 1 = Nasty or Afraid, 10 = extremely friendly):_____ Friendliness towards horses (1-10, 1 = Nasty or Afraid, 10 = extremely friendly):_____ Friendliness towards dogs (1-10, 1 = Nasty or Afraid, 10 = extremely friendly):_____ Can this equine be ridden by: (check all that apply) _____ Not rideable: lameness or injury _____ Not rideable: young age or lack of training _____ Not rideable: ____ old age ____ Children at walk ____ Adults at walk _____ light/medium riding Has this equine been trained or had experience in: (CIRCLE all that apply) Trail, Competitive Trail, Endurance, English Pleasure, Western Pleasure, Driving, Eventing, Jumping (how high? ______), Dressage, Youth Horse, Reining, Barrel Racing, General Western Riding, General English, Other: ___________________________________________________________ Is this equine currently suitable for or have the potential for: (CIRCLE that apply) Trail, Competitive Trail, Endurance, English Pleasure, Western Pleasure, Driving, Eventing, Jumping (how high? ______), Dressage, Youth Horse, Reining, Barrel Racing, General Western Riding, General English, Other: ___________________________________________________________ Describe any competitive experience this equine has:______________________ ________________________________________________________________ Has this equine ever: (check all that apply and explain if “yes”) Bucked? ________ Reared? _________ Kicked? _________ Bitten? __________ Other? __________ Is this equine easy to: (check all that apply) Lead _____ Tie _____ Trailer _____ Clip _____ Describe any current or previous lameness problems: ___________________________ Describe any current or previous health problems:____________________________ ______________________________________________________________________ Does the equine have any special needs? __________________________ Is the equine current on vaccinations? If so, which and when were they last administered?____________________________________________________ What is the date on the equine’s most current Coggins test? ________________ When was the last time the equine’s teeth were floated? ___________________ When was the last time the equine was wormed? _________________________ When was the last time the equine’s hooves were trimmed? ________________ Does the equine get along with other equines? ___________________________ In what kind of housing situation is the equine used to (pasture, stall, etc)____________ What and how much is the equine currently being fed? __________________________ ______________________________________________________________________ Is there anything else you can tell us about the equine that will enable us to help find him/her the best possible home?___________________________________________ Why are you donating this horse to _________________________________ (Name of Organization) ? ________________________________________________________ ______________________________________________________________________ By signing this contract, I, the undersigned donor of the above described equine understand and agree to the following: 1. I am giving up all my rights, title, and interest in the above described equine to ____________________________ (Name of Organization) . 2. There are no liens or claims against the equine, and if any liens or claims are found, I will be solely responsible for them and will indemnify _____________________ (Name of Organization) from all damages ___________________________ (Name of Organization) may suffer due to the initiation of legal proceedings brought against myself and/or ____________________________ (Name of Organization) arising from my former ownership of the above described equine. 3. I am releasing this equine completely and voluntarily. 4. I have read and fully understand the policies of __________________________ (Name of Organization) and realize that in the event the existing policies do not cover a specific situation, will use its best judgment and ability in handling the situation in the best interest of the equine. 5. I understand that once I release the equine, I will not have control over the equine’s care. I understand that __________________________________ (Name of Organization) will provide for the equine per their policies and in the event the existing policies do not cover a specific situation, ____________________________ (Name of Organization) will use its best judgment and ability in handling the situation in the best interest of the equine. 6. I understand that ____________________________ (Name of Organization) will not accept the equine until I have signed and returned this contract, and have provided _______________________________ (Name of Organization) with a copy of the equine’s veterinary records from the previous twelve (12) months. 7. I understand that _____________________________ (Name of Organization) will not accept this equine without a Negative Coggins test from within the last twelve (12) months. 8. I understand that ______________________________ (Name of Organization) may decline to accept the donation of this equine at any time until the equine has been officially accepted into the rehabilitation or adoption program. 9. This Agreement shall constitute the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. 10. Any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if placed in writing and signed by each party or an authorized representative of each party. By signing, I declare that the above information on the equine is true to the best of my knowledge. WITNESS our signatures as of the day and date first above stated. ___________________________ (Name of Organization) ________________________ By:_________________________ (P rinted Name of Donor) _________________________ ________________________ (P rinted Name & Office in Corporation) (Signature of Donor) __________________________ (Signature of Officer)