Name of equine you are applying to adopt: _________________________________________________
Name of Applicant: ____________________________________________________________________
Physical Address & Complete Mailing Address: _____________________________________________
____________________________________________________________________________________
Age and Date of Birth: __________________________________________________________________
Drivers License Number and State of Issue: _________________________________________________
Social Security Number: _________________________________________________________________
Home Phone: ______________________________________ Work Phone: ________________________
Cellular Phone: ____________________________________ Pager Number: ________________________
Place of Employment and Address: _________________________________________________________
_____________________________________________________________________________________
Length of Time with Present Employer: _____________________________________________________
Length of Time with Most Recent Past Employer:______________________________________________
Reason for Leaving Most Recent Employer: __________________________________________________
Gross Annual Household Income: __________________________________________________________
Own/Rent/Live with Relatives: ____________________________________________________________
Does Applicant Live in a (circle one): House Apartment Mobil Home Duplex Condo
Length of Time at Present Address: ________________________________________________________
Length of Time at Previous Address: _______________________________________________________
Where do you plan to keep the equine: (circle one): At your home Board at a friend’s home
Boarding Facility Trainer’s Facility Race Track Facility Other: (please explain): ____
_____________________________________________________________________________________
Will the equine be (circle one): Pastured Stall Kept Contained in a Pen or Paddock
How often will the equine be turned out? _____________________________________________________
Will the horse be kept alone or in the same enclosure as other animals? ____________________________
If the equine will be kept with other horses (or any other animals), please explain the expected living
conditions in terms of space available for each animal, size of enclosure or pasture, etc.:________________
______________________________________________________________________________________
______________________________________________________________________________________
Please describe how you plan to feed the equine to insure that it does not have to compete for it’s full ration
of feed: _______________________________________________________________________________
______________________________________________________________________________________
What do you plan to use this equine for? _____________________________________________________
How much time do you plan to spend riding the horse? _________________________________________
How much time do you plan to spend grooming or doing ground work? ____________________________
Will there be young children around the equine or riding the equine? ______________________________
If so, how many and what ages? ___________________________________________________________
Please explain your level of experience with equine: ___________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Do you own any other animals, if so how many, what species and ages? ___________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Have you ever been cited or warned for abuse of any animal or person? ____________________________
If so, please explain: _____________________________________________________________________
______________________________________________________________________________________
Do you already have a veterinarian in mind to provide veterinary care for this equine? _________________
Do you already have a farrier in mind to provide hoof care for this equine? __________________________
Do you already have tack and grooming supplies on hand to use on this equine? ______________________
Do you own a horse trailer, if so, what kind (stock, 1-horse, etc.)? _________________________________
Do you own a vehicle with which to pull a trailer (if so, please list make, model, year, and whether it is
paid for or not): _________________________________________________________________________
If you have no prior experience dealing with equine or with special needs horses, will you agree to
complete a basic horse care course administered by USESR? _________________________
Please provide the name, address, and telephone number of two close family members not living with you:
1. __________________________________________________________________________________
2. __________________________________________________________________________________
Please provide the name, address, and telephone number of four people who would attest to your good character and how you care for your animals:
1. __________________________________________________________________________________
2. __________________________________________________________________________________
3. __________________________________________________________________________________
4. __________________________________________________________________________________
Thank you for your interest in adopting an equine from USESR. Your application will be processed as quickly as possible.
United States Equine Sanctuary & Rescue
P.O. Box 565 Bridgeport, TX 76426
Toll Free: 877-720-1685
Mail this application along with your $25.00 Filing Fee and your deposit (minimum $100.00). Call if you have any questions.
Your application will not be processed without a deposit and filing fee. Filing fee is waived for members of USESR.
Membership is open to the public.