CENTRAL NEW ENGLAND EQUINE RESCUE, INC.
Mailing address: POB 262 –
ADOPTION APPLICATION
OFFER TO ADOPT
NAME____________________________________
FULL ADDRESS_____________________________________________________
PHONE #________________________CELL________________________
EMAIL ADDRESS______________________________________________
EMPLOYER NAME_____________________________________________
EMPLOYER ADDRESS__________________________________________
HOW LONG WITH THIS COMPANY______________WORK HOURS______
SOCIAL SECURITY #___________________________
REFERENCES
1._________________________________________________________
TELEPHONE #________________________________
2._________________________________________________________
TELEPHONE #________________________________
3._________________________________________________________
TELEPHONE #________________________________
PLEASE CIRCLE:
I currently own a horse I have never owned a horse
I formerly owned a horse
The equine veterinarian who will care for this animal is:
NAME___________________________________________________________
ADDRESS________________________________________________________
PHONE #___________________________CELL_________________________
ADDRESS WHERE HORSE WILL RESIDE:
NAME OF OWNER________________________________________________
STREET ADDRESS________________________________________________
TOWN_______________________STATE__________ZIP CODE___________
THE DAILY FEEDING WILL BE DONE BY___________________________
Page 2
DESCRIBE THE FACILITY WHERE HORSE WILL RESIDE (size of stall, turn out situation, feeding schedule, etc. ________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
IF YOU WILL BE BOARDING, HOW MANY MILES FROM YOUR RESIDENCE IS THE FACILITY_________________
PLEASE READ THE FOLLOWING CAREFULLY. BY SIGNING IT YOU MAY BE GIVING UP RIGHTS YOU MAY OTHERWISE HAVE.
The Adopter agrees to accept all responsibility for any action or lien resulting from any action directly or indirectly involving Adopted Animal while in the care of the Adopter. There fore Adopter agrees and understands that neither CNEER or its representatives will be liable for any damage or injury caused to Adopter or any third person including but not limited to damages or injuries caused by Adopted Animal. If any third person makes a claim against CNEER as a result of any conduct of the Adopted Animal after Adopter has taken possession of it, the Adopter agrees to indemnify and hold CNEER and any of CNEER's representatives harmless from any such claim, including costs and attorney's fee resulting from such claim.
Adopter Signature:______________________________________Date:___________
Print Name:__________________________________
CNEER Signature:__________________________Date:___________