| Applicant Information |
| First Name: |
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| Last Name: |
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| Address Street: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Contact Information |
| Daytime Phone: |
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| Evening Phone: |
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| Email: |
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Please describe your Equine Experience in the box below
|
| Animal Experience Number of years, type of animal(s), breed owned, training and experience level: |
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| Property Information |
Do you Own your own
Property / Pasture |
Yes
No |
| Amount of Acreage: |
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| Type of Fencing: |
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| Type of Shelter - Number of barns, box stalls, lean-to (3-sided shelter): |
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| Water Source: |
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| Feed Type: |
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| Describe horse you wish to adopt: |
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| Other Information |
| Veterinarian Name: |
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| Veterinarian Phone No.: |
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| Farrier Name: |
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| Farrier Phone No.: |
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Which animal are you
interested in adopting?
|
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| Please give us additional informaion including directions to your home of inspection of your property by a HARPS investigator: |
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| Amount of donation to adopt animal: |
|
| Security Code: * |
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