L5 Youth Ranch
&
Horse Rescue
Changing Futures & Changing Lives
PO Box 75
Sprague, NE 68430
402-525-9963 or 64
Equine Adoption/Lease Agreement
Adopter’s Information
Name - _____________________________________________________________________________
Address-____________________________________________________________________________
City, State, Zip - ______________________________________________________________________
Home/Cell/Work Phone - _______________________________________________________________
E-Mail - _____________________________________________________________________________
Drivers License Number - ______________________________________________________________
License Plate Number - ________________________________________________________________
Current Employer - ____________________________________________________________________
Years With This Employer - _____________________________________________________________
Name, Address, and Phone Number of your Vet -____________________________________________
___________________________________________________________________________________
How Many Equines Do You Currently Have? ________________________________________________
Date of Last Vaccination / Vaccinations Received - ___________________________________________
Date the Equine’s Were Last DeWormed - __________________________________________________
What Product Was Used? ______________________________________________________________
Date of Last Negative Coggins, List Dates on all Equines - ___/___/____, ____/___/___, ___/___/____, ___,___,____
If you currently do not have any Equines, have you previously owned any and for how long? __________
____________________________________________________________________________________________________________________________________________________________________
In the past (5) years, have you given away or sold any equines? Explain. __________________________
__________________________________________________________________________________________________________________________________________________________________________
In the past (5) years have you had any equines pass on while in your care? If so, explain. _____________
__________________________________________________________________________________________________________________________________________________________________________
Describe you experience with equines, in detail - _____________________________________________
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Who will be feeding the equine and how often? ______________________________________________
__________________________________________________________________________________________________________________________________________________________________________
How often do you plan to have a farrier trim or shoe the equine? ________________________________
How often do you plan to de-worm the equine? ______________________________________________
How will you house the equine? In barn or pasture? __________________________________________
If in a barn, how big are the stalls and how often will the equine be turned out? ____________________
If the equine is in a pasture, how big is the pasture, in acres?____________________________________
How many other equines will be kept in this same pasture?_____________________________________
What type of horse fencing do you currently use?_____________________________________________
Is your pasture kept free from debris?______________________________________________________
A representative from the L5 Youth Ranch will be doing a home check prior to the final adoption agreement to determine if your residence is suitable for the type of horse you are wishing to adopt. We will also do monthly home checks for up to 2 years. If at any time we feel the equine that was adopted from the L5 Youth Ranch & Horse Rescue is not being cared for properly we reserve the right to confiscate the equine immediately. There will be no refunds given for any reason if the equine is taken from your property for abuse or neglect.
Before the equine leaves the property of the L5 Youth Ranch & Horse Rescue the full adoption fee must be received.
By signing this application, I agree that I have read and fully understand the Adoption/Lease Policy of the L5 Youth Ranch & Horse Rescue. I also understand that I may never sell, give away, lease out, send to slaughter, etc. the equine I adopt/lease. If for any reason I cannot keep the equine that was adopted/leased the equine must be given back to the L5 Youth Ranch & Horse Rescue without any fees to the L5 Youth Ranch & Horse Rescue. I also agree that the L5 Youth Ranch & Horse Rescue is not liable in the event of injury, death, or damage to any human, animal, or property as a result of activities or actions of the equine I adopt/lease.
I agree that all statements that I have made on this form are true.
Adopter’s Signature-______________________________________________ Date-_________________
If it is found that any statements I have made on this form are not true the adopted/leased equine can be confiscated. Initial________
A bill of sale will be drawn up for all equines Adopted from the L5 Youth Ranch & Horse Rescue.
A lease agreement will be drawn up for all equines Leased from the L5 Youth Ranch & Horse Rescue.
