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Horse Application Questionaire - 09.09.09

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					                   THE HORSE TRUST RE-HOMING SCHEME
                        OWNER APPLICATION FORM

Please Print
                           SOME QUESTIONS ABOUT YOU

1. Your full name
   ……………………………………………………………..................

2. Your
   address……………………………………………………………......................

………………………………………………………………………………...................
        .

…………………………………………………………………………………...............
        .

………………….. ………………………………Post code…………………………….

3. Is the horse currently kept at:

    A livery yard                   
    On your own land                
    On rented land                  

4. The address where the horse is kept…………………………………………………..

…………………………………………………………………………………...............
        .

………………….. ………………………………Post code……………………. ……...

5. Your telephone
number………………………………………………………………..

6. Your mobile number …………………………………… ……………………………

7. Your e-mail address …………………………………………………………………..

8. Your
occupation…………………………………………………………….................
9. When do you need to find a home for your horse by?.......................................




                      SOME QUESTIONS ABOUT YOUR ANIMAL

Questions 47-56 are asked so that The Trust has further details about each horse.
This is purely for PR purposes. For question 51, no horse will be assessed differently
or more favourably as a result of any donation you wish to make to The Trust

Please enclose a current photo of your horse with this application and, if possible,
e-mail a copy to liane@horsetrust.org.uk.

1. Name of animal              ……………………………………………………………..

2. Type/Breed                  ……………………………………………………………...

3. Description of animal:
                     a.) Colour                        ………………………………………..

                       b.) Sex                         ………………………………………..

                       c.) Age                         ………………………………………..

                       d.) Height in hands             ………………………………………..

                       e.) Distinguishing marks
                          ……………………………………….

4. How long have you owned the animal?                 ……………………..…..
years/months

5. How many other horses/ponies/donkeys do you own?………………………………

6. Please give the name of the Vet who has dealt with the animal

…………………………………………………………………………………………
        …

7.The Vet’s address ………………………………………………………………...…...

……………………………...……………………………………………………………
.

…………………. ……………………………....Post code …………………………….
8. The Vet’s telephone number     ………………………………………………………

9. When did the Vet last see the animal? ……………………………………………….

10. Why did the Vet last see the animal?
………………………………………………..


…………………………………………………………………………………………...

11. What is the bodily condition of the animal? (please circle)

Underweight                Good                 Overweight

12. Why is the animal no longer able to be ridden? ……………………………………

…………………………………………………………………………………………...

…………………………………………………………………………………………...

13. Is the animal sound?                                                     YES/NO

14. If no, what is wrong? Please include details of any intermittent lameness problem

…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
15. Is the animal currently receiving any medication?                        YES/NO

16. If yes, please outline what medication the animal is receiving and why

…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
17. When was the animal last wormed?
…………………………………………………
18. What was the name of the wormer used? …………………………………………...

19. When was the animal last vaccinated?
………………………………………………

20. Does the animal currently wear shoes?                                     YES/NO

21. If yes, is there any reason why your horse should remain shod during his/her
retirement?

…………………………………………………………………………………………
…
…………………………………………………………………………………………
…

22. When were the animal’s feet last trimmed/when was the horse last shod?

…………………………………………………………………………………………
…

23. When were the teeth last rasped?      ……………………………………………….

24. Does the animal suffer from a dental problem or have difficulty eating?
YES/NO

25. If yes, please provide details about the problem

…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
26. Has the animal ever suffered from a bout of laminitis?                    YES/NO

27. If yes, please provide details about the number of times the animal has suffered
from laminitis and how severely. For example, has the animal suffered multiple bouts
that has led to rotation of the pedal bone?

…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
28. When did the animal last suffer from
laminitis?……………………………………..

29. Does the animal need to be kept on restricted grazing during the summer in order
to manage the laminitis?                                                     YES/NO

30. If yes, please describe in full the measures that you take in order to manage the
laminitis

…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
…………………………………………………………………………………………
…

31. Do you suspect that the animal has Cushing’s Syndrome?                      YES/NO

32. Does the animal suffer from a respiratory problem?                          YES/NO
(This includes where a horse is fed soaked hay or haylage
because it coughs if it is fed dry hay)


33. If yes, please provide details about the problem

…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
…………………………………………………………………………………………
…


34. Can the animal live out all year round?                               YES/NO
35. If no, please explain when/why the animal must be stabled
…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
36. Does the animal suffer from sweet itch?                               YES/NO
37. Does the animal have any vices?                                       YES/NO
    (e.g. does it kick, bite, rear, crib-bite, wind suck or weave etc.)

38. If yes, please describe……………………………………………………………...

………………..………………………………………………………………………….
.

…………………………………………………………………………………………
…

39. Has your horse ever had colic?

40. Is the animal good to:

Catch                                                                     YES/NO
Handle                                                                    YES/NO
Groom                                                                          YES/NO
Clip                                                                           YES/NO
Worm                                                                           YES/NO
Load/Travel                                                                    YES/NO

41. If no, please outline why the animal is difficult

…………………………………………………………………………………………
…
…………………………………………………………………………………………
…



42. Does the animal behave for the farrier?                                    YES/NO

43. If no, please outline why the animal is difficult

…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
…………………………………………………………………………………………
…

44. Is it possible to leave your horse alone in the field/stable, for example if his
companion went out on a ride?                                                      YES/NO

45. What is the animal’s feed regime?

…………………………………………………………………………………………
…
…………………………………………………………………………………………
…
46. Do you currently own a passport for your horse                             YES/NO

47. Is your horse microchipped?                                                YES/NO

48. Is your animal registered with a breed society?                            YES/NO

49. If yes, please give details …………………………………………………………...
…………………………………………………………………………………………...

50. Has the animal won any major awards?                     YES/NO

51. If yes, please give details …………………………………………………………..


………………………………………………………………………………………..

52. Does the animal have any other “claim to fame”           YES/NO

53. If yes, please give details ……………………………………………………………


……………………………………………………………………………………….......

……………………………………………………………………………………….......
.

……………………………………………………………………………………….......
.

……………………………………………………………………………………….......
.

54. Why do you feel unable to re-home your horse yourself?
 (please continue on a separate sheet if necessary)
55. Please provide any other information that you consider may be of relevance to this
application (please continue on a separate sheet if necessary).




As a charity, The Horse Trust relies on donations and legacies to fund its vital welfare
work. This scheme costs The Trust approximately £500 for each horse in the first year
alone.

56. Are you willing to make a monthly donation, however small, to enable us to
continue with this work?                                             YES/NO

If YES, £…….per month (payment can be made using the Direct Debit form enclosed)


57. To help us obtain vital funds, The Horse Trust may seek press coverage on horses
that have been re-homed. Please tick this box if you are NOT willing to be interviewed
by The Horse Trust's marketing team.       


I declare that I am the owner of the above animal and the information that I have given
is true to the best of my knowledge and belief.


Signed ……………………………………………………….. Date
……………………
Print Name ………………………………………………………………………………



Please note that The Trust will hold the information supplied by you in this application
on computer and in paper form for record keeping, data analysis and marketing
purposes. If you have any objections to your data being held in this way, please tick
here 


Have you considered remembering the work of The Trust and the memory of your
animal in your will? If you would like to receive our Legacy Pack please tick here   



                                   THE HORSE TRUST
                       SPEEN, PRINCES RISBOROUGH,BUCKS HP27 0PP
                          REGISTERED CHARITY NUMBER 231748

				
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