Adoption Application Step 1 of 8 12% Welcome to Safe Harbor Equine and Livestock Sanctuary's adoption program. We request the following information so that we can assist you in the selection of a new animal. This form and a consultation with a Safe Harbor representative are designed to help you find the animal most compatible with your lifestyle. We reserve the right to refuse adoption to anyone for any reason. A representative of our group may conduct home visits prior to or following an adoption, and our group has the right to reclaim an animal following an adoption if unsuitable home conditions, evidence of neglect, abuse or other mistreatment of the animal are found on this visit. IN ORDER TO BE CONSIDERED AS AN ADOPTER TODAY, YOU MUST: Be 18 years of age or older. Have identification showing your present address. Have the knowledge and consent of your landlord and/or Homeowners Association (if applicable). Be able and willing to spend the time and money necessary to provide training, medical treatment and proper care for the entire life of that animal. Name of Applicant* Birthdate* *I am adopting for myselfI am adopting for someone elseI am adopting for someone else... Please Explain:* Contact Info:eMail Address* Phone Number*Phone Type*WorkHomeMobileAddressIf you are not in Middle Tennessee, SW Kentucky or Northern Alabama, we may not be able to process your application, but we will try. Regardless of location, you will need to come to the foster home of the animal you wish to adopt to meet in person.* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How many acres of pasture will your adopted animal have access to?*Less than 55 to 1011 to 2021 to 50More than 50This is not the size of your property. This question refers to the amount of fenced in area your horse will actually be turned out in regularly.How many other animals total will share this pasture?*What type of fencing does this pasture have?* Wooden 3 or 4 board Wooden Board and Wire T-Post And Square Wire T-Post and Tensile without Electric T-Post and Tensile with Electric T-Post and Tape or Rope without Electric T-Post and Tape or Rope with Electric Barbed Wire What Type Of Shelter Does Your Property Have?* Barn Without Stalls Barn With Stalls 3-Sided Run-In Shed With Roof Open Shed With Roof Thick Stand Of Trees None Do you own or rent the property where your adopted animal will be living?*OwnRentPlease provide your landlord's contact phone # and email address so we may receive consent for you to keep an adopted animal on the property.*Where will your adopted animal live?*My home address, listed aboveAt a boarding facility, or other leased propertyWith a friend or family memberPlease provide the address where your adopted animal will live*We do a site visit for all adoptions, and will do the site visit where the animal will live in order to see fencing, shelter, etc. Section BreakWhat type of animal are you looking to adopt?*Horse, Donkey or PonyGoat, Chicken, Turkey, Pig, Emu, Llama, Alpaca or CowDog or Cat*HorsePonyDonkeyMule*GoatChicken, Duck or other FowlOtherBarn CatPlease describe in as much detail as possible the temperament, experience level, etc... that you are looking for.* Why do you want this new friend?* Companion Companion for another pet Riding Yard / Pasture Pet Other Please explain "Other" Height and Weight of the Primary Rider*Why do you want this new friend?* As a pet To train and re-sell through the T.I.P. Program To teach my children responsibility Raising my own humane pasture meat As a companion for another pet To enhance my breeding program For milk, eggs or fiber How many years of experience as an Amateur Trainer do you have?*0-55-10More than 10We define an amatuer trainer as an individual who has trained their own horses, horses for family members or a horse for a friend for personal use or re-sale. How many years of experience as a Professional Trainer do you have?*0-12-55-10More than 10We define a professional trainer as an individual who has been paid by someone other than a friend or family member to train a horse not owned by the trainer.What type of riding do you do?* In my own pasture/arena Dressage Huntseat Hunter/Jumper Eventing Western Pleasure Park Pleasure Halter Racing Endurance Harness Racing Barrels, Poles or Other Speed Sports Bronc Riding/Rodeo Roping/Team Roping Ranch Riding Trail Obstacle Challenges Breed Showing (POA, AQHA, Paint Horse, etc) If your horse were injured and unable to continue in your chosen discipline, what would you do? (i.e. humanely euthanize the horse, return the horse to rescue, seek a new home for the horse, allow him/her to retire at my farm, etc...)* Mark the sentence that best describes your experience level with a horse.* I am brand new to horses, and do not plan on taking lessons or getting any training for the horse. I am only interested in horses that are broke to ride and ready for a beginner. I am brand new to horses, but I am willing to learn and grow with a horse that has already been started and may need more work. I either already have a trainer to work with, or would like a rescue recommendation for a trainer. I have never owned a horse before, but I've ridden a leased horse, lesson horse, or gone to camp for many years of my life and cared for horses and ridden horses there. I have friends who own horses and I am around them a lot. I have been riding for under five years and already have a good veterinarian, farrier, and equine support group to help me work through any issues I may have with my horse. If anything is beyond my skill level, I would be comfortable talking to a trainer I know and hiring a trainer for myself or the horse if needed. I've been riding for over five years, and consider myself to be intermediate. I know the style of riding I like, and I know what I would like my horse experience level to be. I understand herd dyamics, how to ride through a spook, and how to do some basic training/refresher work. I am a lifelong horse owner, or I have had years of quality training, and consider myself to be advanced. I may have started a colt before, or at least worked with a difficult or challenging horse in the past. I don't expect everything to be a walk in the park, and can handle working through a few issues myself. I can train horses, and could take on a project horse from scratch if I wanted to. Please review the adoption profiles from our website and mark at least 1, and up to 3 animals that you have a specific interest in. While you may express interest in a horse on legal hold, we will have to waitlist you for adoption until after court proceedings are completed, as we cannot legally adopt out animals on hold pending court.*Beethoven (Mini)Cool MacDaisy (Pot Bellied Pig)Darla (Goat)DC Piggy BankEve (T.I.P Eligible)Five CentFreda (Goat)GatsbyHenry GramIrma (Goat)Kate (Goat)Liza (Goat)JavertLiz (Mini)Peter (Pot Bellied Pig)Rosie (Companion - Fee Waived)Santiago (Companion - Fee Waived)Snow FlowStella (T.I.P Eligible)Sweet Serenata (Companion - Fee Waived)Sweet PeaVerdi (Mini)Vivian (Goat)WilsonNone of the Above..I want to become approved and waitlisted for a horse/livestock animal that better suits my needsIMPORTANT: Choose a minimum of 1 and maximum of 3 names from this list!Please Mark Checkboxes Corresponding To Types of Horses You Will Consider:* Mare Gelding Gaited Non-Gaited Check ALL That Apply Is this your first animal you will care for of this type (horse, pony, goat, etc)?*YesNoDo you own a horse, pony or donkey now?*YesNoNo, but I am responsible for a horse owned by a friend, or family member or I lease a horse and am responsible for my leased horse.No, but it has been less than 2 years since I had my last horse, pony, or donkey.Who is your farrier?*Your Farrier's Phone # is:*How often do you have your farrier come trim?*Every 4 WeeksEvery 5 to 6 WeeksEvery 7 to 8 WeeksA couple times a yearNo Set Schedule, Just as NeededWould you be willing to attend a basic horsemanship class with your family that is sponsored by Safe Harbor?*YesNoHorses are companion animals and should not be isolated in a pasture. Are you willing to adopt a second horse, mini horse, donkey, or mule to be a companion?*YesNoWhat type of companion equine do you prefer?* Have you ever owned an animal of any type before?*YesNoI had pets as a kid, but this will be my first adult pet responsibility.What kind(s) of animals have you had in the past?*Which of these do you still have? (Include age, sex, breed, and whether pets live outdoors or indoors).*Are all animals in your home current on vaccinations?*YesNoI don't know.Are all of your male pets castrated and females spayed if species appropriate?*YesNoI don't know.What happened to the animals that you no longer have (i.e. gave away, died, ran away, sold, euthanized)?*What Is Your Veterinarian's Name?* First Last Clinic Name What Is Your Veterinarian's Phone #?*Which of the following services/vaccinations do you have your veterinarian or other equine healthcare practitioner provide your horse annually? If you do not currently own a horse, please indicate what you did have provided for your last horse.* 5 Way Vaccine Annual Wellness Exam Dental Float Strangles Vaccine Rabies Vaccine West Nile Vaccine Potomac Horse Fever Vaccine Botulism Vaccine Artificial Insemination Services Sheath Cleaning Chiropractic Adjustment Accupuncture We do not use a vet for vaccines; we purchase them and self-administer them. Our horse has never been sick, so we have never needed a vet. Have you ever bred any of your animals?* Yes No Answer yes if you have intentionally or accidentally had any of your animals get pregnant.Was the breeding on purpose or an accident?* On Purpose Accidental What was the purpose of the breeding?* I love babies and think they are cute and fun I was able to sell the baby or babies for a profit I have a very well bred female and found a sire that was also well bred so I bred for pedigree I have a horse with very good conformation and disposition and found an equally well bred sire and I bred to enhance positive attributes in the breed. No real reason, it just seemed like a good idea at the time. What happened to the babies that you have bred?* I still have all of them. I sold them and I know where he/she/they are today. I sold them, and have not followed up on where they are. If you adopt a female horse, pony or other livestock animal from us, do you want her to have babies?* Yes No I haven't really considered it, but maybe Only if I adopt a registered animal Have you ever turned an animal in to a shelter or rescue?*YesNoPlease explain...* Will you use a trainer for yourself or your horse?*YesYes, but I need a referral and don't already have one.NoWhat is the name of your trainer?*What is your trainer's phone #?* Are you prepared to care for your adopted animal for the remainder of its life? Please note that some animals such as horses and ponies can live to be over 40 years old.*YesNoWrite your full name below as a digital signature acknowledging the following: Tennessee Law, code 44-20-101-105 states that "an equine sponsor or equine professional, or any other person, including corporations and partnerships, are immune from liability for the death or injury of a participant, which resulted from the inherent risks of equine activities." You have read and understand the law, and release Safe Harbor its foster farm owners, and volunteers from any liability for any injury or accident (up to and includng death) to you or your family members and/or guests, resulting from your interaction with a Safe Harbor equine or equine facility before or after adoption. Your further take responsibility and assume all liability for any family members, trainers, or guests that you choose to bring to a Safe Harbor foster farm or facility at any point during or after the adoption process.*Please write your full name and today's date below to acknowledge and agree to the following consent: Safe Harbor Equine and Livestock Sanctuary or their authorized representative may contact my veterinarian and/or farrier to complete a reference check. My Veterinarian is authorized to release any information requested about the care and treatment of my animals including vet records if needed.*How did you learn about Safe Harbor Equine and Livestock Sanctuary? Do you have any questions or comments?