Applicant's Name
Applicant's DOB
Phone #
Street Address
Email Address
City/State/Zip
Which horse are you interested in and why?
How many horses have you owned in the past and how many do you own now?
Describe your experience with the following:
Riding:
Handling
Training
Experience with young/unbroke horses
What discipline(s) do you ride? (English, dressage, trail, western, etc)  What kinds of activities do you hope to
participate in with this horse?
Veterinary/Farrier Care
Please list the name, address, and phone number of your equine veterinary.
May we contact your vet as a reference?
Yes
No
If 'No', why not?
Please list the routine vet care you plan to provide for this horse
Please describe your deworming program.
How often will you have this horse trimmed/shod?  Will you provide shoes if necessary?  
Please list the name, address, and phone number of your farrier.
May we contact your farrier as a reference?
Yes
No
If 'No', why not?
General Care
Will the horse be kept on your property or boarded elsewhere?
If the property belongs to someone else, please list name, address and contact information:
Number of horses that share this pasture?
Number of acres the horse will be pastured on:
Describe the breed and genders of the other horses:
Describe the shelter available to the horse and the amount of time it may spend stalled.  Please describe the size
of available stalls and shelters.
Please describe your fencing.
Please describe your feeding program
Please share any additional information that you feel is relevant
By submitting this form, you hereby certify that all of the information contained herein is correct and true.
REFUGE RANCH
Thank you for inquiring about a horse available for adoption through Refuge!  We appreciate your taking the time to provide us with some
general information that will allow us to assure the adoption is a good fit.  We have very few adoption requirements set in stone.  Our goal is
simply to place each horse in the best home possible!  We are more than willing to work with adopters in various situations to make this
happen!  Please feel free to contact us for more information or with any additional questions.
3845 Delay Rd       Pawnee, IL        62558        217-498-7679       email:  refuge@refuge-ranch.org