Leg Up Farm - Potential Program Horse Questionnaire

Dear Horse Owner,

Thank you for your interest in Leg Up Farm. Our equine staff appreciate the opportunity to learn more about your horse. We evaluate each horse individually and determine collectively whether your horse is likely to be a good fit for our program. As a whole we are looking for a horse that has a calm demeanor, is honest and completely sound at walk, trot and canter. Horses are accepted as donations or free leases, typically at the horse owner’s discretion.

In order to evaluate your horse, we ask that you:
• Complete the attached questionnaire, which asks about the horse, the horse’s history, as well as details about the horse’s management.
• Send us a short video. The video should show your horse schooling on the flat as well as demonstrating any other training your horse currently has such as over fences, dressage movements, western patterns, etc.
• If the horse appears to be suitable, a staff member may request to meet and ride the horse where it is currently stabled (with the facility owner's permission) or we may ask that the horse be trailered to our facility for a trial ride.

Horses that appear suitable for the program are brought in to undergo a trial period, during which the horse is ridden by staff and clients. At the conclusion of the trial a staff member will contact you in regards to the outcome. If all goes well, any lease or donation paperwork will be finalized at this time.

The horses in our therapeutic riding program are valuable members of our team and are highly respected by our clients, families and staff. On top of a high quality of care, we also work with multiple equine professionals to keep our horses happy and in peak condition to do their job.

Please complete the Potential Program Horse Questionnaire and e-mail, fax or mail it to the address below, care of our barn manager. In order for us to view your horse, you may mail us a DVD, e-mail the video or a link to access the video on another site such as www.youtube.com. Please feel free to contact us with any questions and check out our website at www.legupfarm.org.


Sincerely,

Hannah Hassinger, Barn Manager
Email: hhassinger@legupfarm.org
Phone: (717) 266-9294
Fax: (717) 384-8071
4880 N. Sherman St. Ext
Mt Wolf, PA 17347

Email address *
Owner's Name: *
Your answer
Owner's Address *
Your answer
Owner's Phone Number
Your answer
Horse's Name: *
Your answer
Registered or Show Name (if applicable):
Your answer
Breed: *
Your answer
Age: *
Your answer
Is the horse registered?
Address where horse is currently located: *
Your answer
Height: *
Your answer
Color and Markings:
Your answer
How long have you owned the horse? *
Your answer
Where did you get the horse?
Your answer
How would you rate your horse's temperament on a scale from 1 to 10? *
Bomb proof
Highly reactive, horse can only be handled by a professional
Are you interested in leasing, donating or unsure?
Training (check all that apply) *
Required
Is there any other training this horse has had that you would like us to know about?
Your answer
What type of bit do you usually use on your horse for flatwork?
Your answer
What type of bit do you usually use on your horse for jumping?
Your answer
This horse is best suited for what type of rider(s). (check all the apply) *
Required
If the horse is "being bad" under saddle, what might it do?
Your answer
Has your horse been shown? *
If yes, at what level?
How often is your horse shown?
How often per week and for how long is your horse, currently, being worked? *
Your answer
In a given 24 hour period, how much is your horse usually in a stall? Or turned out to pasture? *
Your answer
Does your horse have any stable vices? *
Your answer
Does your horse currently have any abnormal health conditions? If yes, what are they? How are they managed? *
Your answer
Is your horse on any medications? If yes, please include names.
Your answer
Has your horse had any joints injected? If so, what joints and date(s)?
Your answer
Has your horse ever needed non-routine veterinary care in the past? (i.e. colic, lameness, injury) If yes, please explain.
Your answer
Does your horse have a history of any chronic lameness issues? If yes, please explain. *
Your answer
Has your horse ever been lame? If yes, please explain; include dates, length of time, contributing factors, etc. *
Your answer
Is there anything else you would like to tell us about your horse?
Your answer
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