Equine Owner Surrender Form
Please fill out form as truthfully as you can to your knowledge. This will help us when getting to know the horse as well as the owner. By typing your name here you are agreeing that serves as your signature. If you are not sure of the answer to a question, N/A is fine.
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Name of Owner surrendering horse and Date Of: *
Address, Phone #, Email *
Horse breed, age, and height if known  *
Equine's Name and Tattoo Number if applicable. *
How long have you owned the equine? *
Previous use for the equine? *
Is the equine registered? *
Does equine have a current coggins? *
Please check any of the following the equine has had, or currently has. *
Required
Current Veterinarian and Farrier Name and Phone # (If Applicable) *
Last date seen by Vet. (If applicable)
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Last date seen by Farrier. (if Applicable)
MM
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DD
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YYYY
Please give a brief description of the equine's riding ability. *
Please describe any and all habits the equine has. Good or bad, on ground or under saddle. *
Has this horse ever hurt anyone or been dangerous in any way? Please explain. *
Is this equine dangerous to other animals? If so, please list the animals. (dogs, cats, etc). *
Is this equine food aggressive? *
To your knowledge, has this horse had any of of the vaccines listed. Check any of the following that apply. *
Required
Has this horse been wormed recently? If yes, what date? *
To the best of my knowledge, the above information about the equine's riding history, temperament, and medical treatments is true and correct. Please print your name. *
HAVING SOLE OWNERSHIP OF THE HORSE LISTED ABOVE, I/WE HERBY SURRENDER THE HORSE (HORSE'S NAME), REGISTRATION NUMBER OR TATTOO NUMBER, TO A&A HORSE HAVEN RESCUE AND REHABBING FACILITY, AND THERBY RELINQUISH ALL OWNERSHIPS OF THIS ANIMAL.  (PRINT EQUINES NAME, SIGN OWNER'S NAME) 
 *
I UNDERSTAND THAT A&A HORSE HAVEN WILL NOT BE RESPONSIBLE FOR ANY FINCIAL OBLIGATIONS INCURRED BY ME ON MY BEHALF OF THIS HORSE PRIOR TO A&A HORSE HAVEN TAKING CONTROL OF THE HORSE.                (SIGN NAME)
 *
SHOULD A&A HORSE HAVEN FIND A SUITABLE HOME FOR THIS HORSE, I UNDERSTAND THAT I AM CONSENTING TO THE ADOPTION OF THE HORSE BY AN INDIVIDUAL/ ORGANIZATION APPROVED BY A&A HORSE HAVEN.        (SIGN  NAME)
 *
I UNDERSTAND AND AGREE THAT I AM TRANSFERRING FULL LEGAL OWNERSHIP OF MY EQUINE LISTED ABOVE TO A&A HORSE HAVEN AND THEY HAVE FULL AUTHORITY FOR ALL NECESSARY VETERINARIAN PROCEDURES.              (SIGN NAME)
 *
OWNER SIGNATURE AND DATE OF APPLICATION
 *
A&A WITNESS SIGNATURE
A&A REPRESENTATIVE SIGNATURE
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