| * Required fields |
| Name *
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| E-mail Address *
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| Phone number (with city and area codes): * |
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| Full mailing address (with city, state and ZIP): * |
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| Full address where animal will live (with city, state and ZIP): * |
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| Do you rent or own? |
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| If renting, does your lease permit equines? |
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| Will the equine be boarded? |
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| If yes, please provide the address of the boarding stable (include city, state and ZIP) |
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| Boarding stable phone number: |
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| Do you have adequate shelter? * |
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| Please describe your facility: * |
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| Do you have other equines? |
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| What will the equine be used for? |
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| Will children be riding or caring for the horse? |
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| If yes, how old are the children? |
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| Please explain your level of experience with horses: |
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| Have you ever worked with an abused animal? |
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| If yes, please explain |
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| Have you ever been cited or warned for abuse or neglect of any animal? |
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| If yes, please explain: |
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| Can you commit to caring for an animal for it’s lifetime? |
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| Have you sold or given away an animal within the past 5 years? |
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| If yes, please explain |
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| What will you do with the equine if you have to move or go on vacation? * |
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| Please tell us how you will care for the animal: |
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| Please give name, address and phone number of your vet: |
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| Can you provide references? |
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| Are you willing to provide regular updates, including pictures and yearly vet statements if asked and allow |
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| Do you understand Perfect Harmony’s right to repossess the animal if there is proof of neglect or abuse: |
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| Do you understand that placed animals can not ever be given away or sold? |
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| How did you hear about us? |
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