SCARLET ROSE FARM
EQUINE RESCUE


A Non-Profit Organization Dedicated to Saving Equines From Slaughter

Surrender/Ownership Release Form

 

Scarlet Rose Farm Equine Rescue
29 Buckingham Road
New Milford, CT 06776
(860) 488 - 0953
srfrescue@aol.com

Horse Ownership Release/Surrender Form

Horse Nickname _______________________
Full Registered Name ___________________________
Registration Association and # ________________original breed papers with signed transfers must be submitted with this form

Breed _____________________
Age _______
Gender______________
Color__________________

Descriptive Markings and Brands: ______________________________________________________
______________________________________________________

Surrender Fee:

A non-refundable surrender fee is due to SRFER on the date of pickup/arrival.

Fee: $________

Current Owner Information:

Current Owner ________________________
Street Address _________________________________

City ___________________
State _____
Zip Code _________
Home Phone ____________________

Cell Phone _________________
Work Phone _________________
Email ______________________

How long with current owner? ___________________
Prior to current owner? ___________________

Reason for surrendering horse to Scarlet Rose Farm

_______________________________________________

Medical and Temperament History:

Most recent vaccinations including date administered: _______________________________________

Most recent worming including date administered and product used: ___________________________

Does this horse have a current negative Coggins test? _____ (if so, original Coggins test must accompany this form)

Has this horse been vaccinated for West Nile Virus within 6 months?______
Stand tied?___________

Does this horse load into a trailer? _____
Lead? _____
Clip? ____
Stand for the hose? ____________

Stand for the farrier?______
Stand to be wormed/vaccinated? _____________

Known unsoundness, lameness, or other medical conditions:_________________________________________________
_________________________________________________________

Current treatment or veterinarian recommendations: ________________________________________
_________________________________________________________

Any known feed or medication allergies? _________________________________________________________

Please list all known special needs, overall temperament, any likes/dislikes, quirks, vices, and any other necessary or useful information:_________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

On a separate sheet of paper, please write up a brief (or not so brief) history of this horse. Also, if you have any preferences for the type of adoptive home you would like to see this horse go to, let us know. We can’t promise specifics when placing horses into new homes, however we do try to take into account the type of situation owners would like to see their horse go to.


Release:

I , _______________________ agree that the above information is true to the best of my knowledge. I understand that by signing this form, I agree to surrender legal ownership of my horse(s) listed above to Scarlet Rose Farm, Inc. It is understood that the surrendering party shall hold Scarlet Rose Farm and all it’s officers, directors, employees, and volunteers harmless from any claims of damage, injury, or acts of negligence arising from this surrender. I have read and thoroughly understand this release of liability and agree to abide by it.

Owner____________________________ Date____________