MHWC HAY BANK APPLICATION

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

NAME OF APPLICANT *

APPLICAN'T'S ADDRESS (include city) *

MI COUNTY *

PREFERRED PHONE NUMBER *

EMAIL ADDRESS *

HAVE YOU READ OUR ELIGIBILITY GUIDELINE POLICIES? *

This is required before submitting an application. Please visit http://www.michiganhorsewelfare.org/hay-bank

YES

HAVE YOU RECEIVED ASSISTANCE FROM THE HAY BANK BEFORE? *

Yes

Maybe

HOW MANY EQUINES ARE IN NEED OF FEED ASSISTANCE? *

PLEASE LIST ALL HORSES, INCLUDING SEX, AGE AND BREED *

PLEASE LIST NUMBER OF YEARS YOU HAVE OWNED EACH HORSE *

ARE THE EQUINES ON PROPERTY OWNED BY YOU? *

YES

PHYSICAL ADDRESS OF EQUINES IF DIFFERENT THAN ABOVE

NAME OF CURRENT VETERINARIAN *

PHONE NUMBER OF CURRENT VETERINARIAN *

DATE OF LAST VETERINARY VISIT *

NAME OF CURRENT FARRIER *

PHONE NUMBER OF CURRENT FARRIER *

DATE OF LAST FARRIER WORK *

DATE OF LAST DENTAL CHECK *

NAME & PHONE OF CURRENT HAY SUPPLIER

DO YOU HAVE ANY PREGNANT MARES, FOALS OR STALLIONS ON YOUR PROPERTY? *

YES

IF YOU HAVE STALLIONS, ARE YOU WILLING TO GELD THEM?

YES

Clear selection

WILL YOU ALLOW A MHWC VOLUNTEER OR OTHER ANIMAL CARE PROFESSIONAL TO ASSESS THE CONDITIONS OF THE EQUINES IN NEED OF ASSISTANCE? *

YES

HAVE YOU EVER BEEN CONTACTED BY ANIMAL CONTROL WITH CONCERNS ABOUT YOUR EQUINES? *

If YES, please explain

DO YOU GIVE PERMISSION FOR A MHWC REPRESENTATIVE TO CONTACT YOUR VETERINARIAN AND/OR FARRIER WITH QUESTIONS ABOUT THE EQUINES IN YOUR CARE? *

YES

DO YOU AGREE TO NOT SELL, GIVE AWAY OR TRANSFER ANY HAY OR FOOD PURCHASED BY THE MHWC? *

YES

PLEASE BRIEFLY EXPLAIN WHY YOU ARE IN NEED OF ASSISTANCE? *

HOW DO YOU PLAN TO CARE FOR YOUR EQUINES AFTER ANY PROVIDED MHWC ASSISTANCE RUNS OUT? *

IF YOU DO NOT HAVE A LONG TERM CARE PLAN IN PLACE, THE MHWC WILL RECOMMEND REHOMING YOUR EQUINES. ARE YOU INTERESTED IN ASSISTANCE IN REHOMING ANY OR ALL OF YOUR EQUINES? *

Yes

Maybe

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms