This form is used in the Equine Rescue Network’s Micro Rescue Program’s application and approval process. Forms will be saved as records. The vet used as a reference on the adopters application will be required to fill out the application. It is also acceptable for the office manager to fill in basic information. Questions should be answered to the best of the vets knowledge.

Adopter (New Owner) Name: *

Veterinarian Name: *

Email Address: *

Name of Practice

Practice Address

------ Veterinarian Reference ------

Do you recommend the adopter? *

How long have you been providing services to the named adopter?

Have you visited the adopter's facility? How often do you visit the named facility?

Would you consider the adopter capable of handling the unknown behavior and health risks of a rescue?

How many total horses are housed at the facility?

How many horses are owned by the adopter?

Additional Comments

Please provide your signature below: *

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ERN is required by law to make sure equestians are aware of the dangers of horses! Please see warning below and visit MA Law Section 2D to learn more.

WARNING

Under Massachusetts law, an equine professional is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities, pursuant to section 2D of chapter 128 of the General Laws.

If this horse ever transfers ownership, please notify the ERN so we can update our records.