Another Chance 4 Horses

166 Station Rd., Bernville, PA  19506 / Phone: 610-488-1426/ Fax: 610-488-1234
A Nationwide Community non Profit 501(c)(3) Organization (Non Profit Tax ID# 20-0285993) - Donations are tax deductible

    ADOPTION FORM         

________________________________________________________________________________________________________________

OFFER TO ADOPT (description or name of horse):            

Name:  

Email Address:

My Telephone #

Cell Phone #

Address:

Employed by                    Title

Address__________________________________Telephone_________

How long with this company?______

Drivers License:                 State:

REFERENCES:

1._________________________________________________________

Telephone__________________ 

2._________________________________________________________

Telephone__________________

3._________________________________________________________

Telephone__________________

Please circle.

I currently own a horse / burro.

I have / have not owned a horse / burro.

The equine veterinarian who will care for this animal is: 

Address__________________________________Telephone__________

The type of corral or stall which will be provided

is:_________________________________________(size___________)

I will board this animal at above residence

Telephone______________________Business hours______________

The daily feeding will be done by __________________. 

Cont’d…

The boarding facility is ________miles from my residence. The training will be done by_________________________Telephone_____________

PLEASE READ THE FOLLOWING CAREFULLY.  BY SIGNING IT YOU MAY BE GIVING UP RIGHTS THAT YOU MIGHT OTHERWISE HAVE.

     I will have a veterinarian examine the horse once each year and follow any recommendations the veterinarian feels are necessary if approved by Another Chance 4 Horses. I will be solely responsible for all expenses for this examination. I will direct the examining veterinarian to send written notice of findings and completion of said examination within seven (7) days after completion to Another Chance 4 Horses 166 Station Rd. Bernville, PA  19506.

 This horse will remain the property of the Another Chance 4 Horses. 

If this offer is accepted by Another Chance 4 Horses, I agree that said animal shall reside with the minimum corral space of three hundred (300) square feet, with sanitary living conditions, constructed of wood or pipe, with shelter from the elements and will be provided with inoculations as recommended by Another Chance 4 Horses.  I understand and agree that said animal may not be sold, given away, lent, leased, sold for slaughter, removed from my personal supervision or moved from the address described herein without Another Chance 4 Horses prior approval and that if I am proved in violation of any of the above, I shall be subject to legal action. I agree that an authorized representative of Another Chance 4 Horses may enter the property where said animal resides to determine if all conditions of this agreement are being complied with.  I further offer that should I violate any of these terms an authorized representative of Another Chance 4 Horses may enter upon the land where said animal resides, and take immediate possession of said animal.

     I further agree to accept all responsibility for any action or lien resulting from any action, directly or indirectly involving said animal while it is in my care. Therefore, I agree and understand that neither Another Chance 4 Horses nor its employees or agents will be liable for any damages or injury caused to me or any third person by the animal once I receive delivery of it, including but not limited to damages or injuries caused by the fact that the animal does not behave or perform in the manner I expected.  Further, if any third person makes a claim against Another Chance 4 Horses or any of its employees or agents as a result of any conduct of the animal after I have taken possession of it, I agree to indemnify and hold Another Chance 4 Horses, its employees and agents harmless from any such claim, including costs and attorney's fee resulting from such claim.    

     I will be responsible for returning the horse to the Another Chance 4 Horses or I will pay all costs involved in their return by an authorized representative of Another Chance 4, if I am unable to care for the animal,  or if I am found in default of any of the conditions of this agreement. In the event of my death during this agreement, I direct that funds from my estate be used to return the horse herein described to Another Chance 4 Horses.

   If the animal is determined by a veterinarian to be in a debilitated or unhealthy condition on return, I will be responsible for all costs incurred to return the animal to healthy condition.   In the event the undersigned fails to comply with the terms of this Application and Agreement, Another Chance 4 Horses reserves the right to commence legal proceedings to recover the horse, and the undersigned shall be liable for all costs, inclusive of attorney’s fees, in connection with such legal proceeding.

Additional Requirements or Waivers (Must be approved by Another Chance 4 Horses.)

Another Chance 4 Horses ID Number or description of Adopted animal:

The above offer is accepted by Another Chance 4 Horses.

Signed_________________________________________

Date________

The above offer is accepted by Adoptor.

Signed_________________________________________

Date________