Name of Person*Phone*Email* How did you hear about the equine surrender program?*How soon are you looking to surrender your equine?*Name of Horse*Address of Horse*(must be located in Colorado) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Color*Breed*Age of Horse*Sex*MareGeldingStallionHeight*Has your horse been halter broke?*YesNoIs your horse a riding candidate?*YesNoDoes your horse exhibit any lameness in hooves, joint or legs?*YesNoDo you have a Brand Inspection?*YesNoIs the horse registered?*YesNoIs your horse healthy (not displaying any clinical signs of disease/illness)?*YesNoDoes your horse have any conformational defects that would affect its rideability?*YesNoWhy are you relinquishing your equine?*Do you have any other equines?*Has your horse bitten or kicked anyone in the last 12 months?*Any known safety issues for either the horse or the handlers?*Where you get the horse from?*How long have you owned the horse?*Is the equine broke to ride?*How many times a week do you ride the horse?*How well does the equine get along with other equines?*Any medical issues? Please describe.*How is your equine with the veterinarian?*Has the equine had professional training?*Does the equine live in a pen, stall or pasture?* Pen Stall Pasture Has your equine shown any aggression towards the following:* Unfamiliar Adults Familiar Adults Unfamiliar Children Familiar Children Equines Dogs Cats Other No aggression seen Last known date of teeth examination/floatLast known date of farrier treatmentLast known date of deworming treatmentProduct UsedIvermectinFenbendazole/oxibendazolePyrantelLast known date of vaccinationsHorse vaccinated for (check all that apply) Eastern Equine Encephalitis Western Equine Encephalitis West Nile Virus Rhino (EHV1 and EHV 4) Influenza Tetanus Rhino/ Flu Rabies Photo* Drop files here or
