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  1. 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                                                         

 

  1. 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