MHWC HAY BANK APPLICATION
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
HAVE YOU RECEIVED ASSISTANCE FROM THE HAY BANK BEFORE? *
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? *
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? *
IF YOU HAVE STALLIONS, ARE YOU WILLING TO GELD THEM?
Clear selection
WILL YOU ALLOW A MHWC VOLUNTEER OR OTHER ANIMAL CARE PROFESSIONAL TO ASSESS THE CONDITIONS OF THE EQUINES IN NEED OF ASSISTANCE? *
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? *
DO YOU AGREE TO NOT SELL, GIVE AWAY OR TRANSFER ANY HAY OR FOOD PURCHASED BY THE MHWC? *
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? *
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