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- General Information (All fields must be completed. If non-applicable, enter n/a.)
Name
Address City, State, Zip
Home Phone Alternate Phone
Email Address Alternate Email
- Equine Information (All fields must be completed. If non-applicable, enter n/a.)
Equine Name BEHS No. Age
Breed Color, Markings, Brands, etc
Date of Adoption: Date of Return: Adoption Fee:
Current negative Coggins? (circle one) Yes No Current Vaccinations? (circle one) Yes No
Note: Current Coggins form and records of vaccinations must be attached.
Current equine worming program:
Current Feeding Program:
Veterinarian’s Name: Phone Number:
Reason for Return:
I, the undersigned, agree to relinquish all ownership, rights and interest in the above referenced equine to Bluebonnet Equine Humane Society. I certify that no claims or liens exist against said equine to the best of my knowledge. However, if any claims or liens were placed on the equine while in my custody, I assume full responsibility for such and will not hold BEHS liable. If legal proceedings are initiated against myself or BEHS arising from my custody or care of said equine, I agree to assume full responsibility and hereby release BEHS from all liability.
In signing this contract, I attest that I am voluntarily releasing custody of the above referenced equine completely and fully to BEHS. I understand that in such cases BEHS policies do not fully address specific or unforeseen situations, BEHS will determine what is necessary and take such action, to the best of their ability, so as to ensure that the best interests of the equine are met. I further understand that the returned equine must have official documentation of current negative Coggins and documentation of currency on all vaccinations required by BEHS policy or these expenses will be deducted from any refund to which I may be entitled.
This contract supersedes any prior understanding and oral or written agreement between the undersigned adopter and BEHS. No amendment or variation of this contract shall be effective unless in writing and signed by or on behalf of each of the parties hereto.
Adopter’s Signature Date
BEHS Representative Signature Date