CENTRAL NEW ENGLAND EQUINE RESCUE, INC.
96 New Braintree Road
West Brookfield, Ma 01585
Tel# 978-621-6717 or 413-265-3270

ADOPTION APPLICATION

OFFER TO ADOPT

NAME____________________________________

FULL ADDRESS_____________________________________________________

PHONE #________________________CELL________________________

EMAIL ADDRESS______________________________________________

EMPLOYER NAME_____________________________________________

EMPLOYER ADDRESS__________________________________________

HOW LONG WITH THIS COMPANY______________WORK HOURS______

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___________________________

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:___________