Horse Donation Application
OWNER INFORMATION:
Name:
Address:
City :
State:
Zip:
Phone#:
Email:
EQUINE INFORMATION:
Equine Name :
Breed:
Age :
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Gender:
Male
Female
Color:
Height:
9
10
11
12
13
14
15
16
17
18
19
20
21
22
1
2
3
hh
City :
State:
Zip:
Phone#:
Email:
Discipline(s):
Is your horse/pony able to walk/trot/canter/jump? If not, please explain:
Does your horse/pony have lameness issues? Please explain:
Does your horse/pony have physical/psychological problems that call for routine treatment?
Please explain:
Does your horse/pony load trailer?
Why would you like to donate your horse/pony to Lift Me Up! Therapeutic Riding Program?
Please explain:
Do you have clear title to this equine? :
Yes
No
Where is your horse/pony currently stabled?
Due to space and program restrictions at any given time, we may not be able to accept
new equines into our riding program immediately. Are you able to delay this donation if
space is currently unavailable?
Please include any additional information you wish to provide in the space below: