General Adoption Form

Has this equine ever suffered from any of the following, either while in your care or prior to your care? If YES, provide specific info. including dates (or approx), type of treatment and by whom, results of any x-rays, who has those x-rays/records and current status:
Colic
Cushings Disease
Eye problems or loss of sight
EPM
Founder
Heaves
Lameness
Navicular Disease
Surgical Procedures

I need hauling service
Would you like to be informed about this animal's status periodically?	Yes No
How would you like to be informed	eMailHome Phone Mobile PhoneUS Mail
By signing below, the signer agrees that he/she is sole and legal owner and that there are no liens or judgements owed on this equine
First Name
Last Name
Email Address
Home Phone
Mobile Phone
Work Phone
Address Line 1
Address Line 2
City
State
Zip

Signature_________________________________________________ Date ______