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2)
PLEASE
TYPE YOUR ANSWERS IN, THEN PRINT.
IF YOU HAVE A PARTICULAR FOAL/HORSE IN MIND, PLEASE INDICATE THE NAME/S:
1. 2.
WHAT DISCIPLINE OF RIDING OR DRIVING DO YOU WISH TO PURSUE WITH YOUR NEW HORSE?
PLEASE TELL US ABOUT YOUR EXPERIENCE AND SKILLS AS A HORSE PERSON:
MAY WE CONTACT YOUR VETERINARIAN AS A REFERENCE? YES OR NO:
VETERINARIAN'S NAME: PHONE NUMBER:
STREET ADDRESS:
CITY, STATE, AND ZIP CODE:
MAY WE CONTACT YOUR FARRIER AS A REFERENCE? YES OR NO:
FARRIER'S NAME: PHONE NUMBER:
STREET ADDRESS:
CITY, STATE, AND ZIP CODE:
IN ADDITION TO YOUR VETERINARIAN AND FARRIER, PLEASE LIST TWO OTHER REFERENCES - NOT RELATED TO YOU - WHO CAN ATTEST TO YOUR SKILL WITH HORSES:
FIRST NAME: TELEPHONE NUMBER:
STREET ADDRESS:
CITY, STATE, AND ZIP CODE:
SECOND NAME: TELEPHONE NUMBER:
STREET ADDRESS:
CITY, STATE, AND ZIP CODE:
OTHER COMMENTS:
PLEASE PRINT AND SIGN AND DATE.
By signing this form you are indicating that all information as stated on this form is accurate and true to the best of your knowledge.
_____________________________________________ ___________________________________
PROSPECTIVE ADOPTEE'S SIGNATURE DATE
Thank you for your interest in adopting a horse from E.P.O.N.A. Please fax this prospectus to 603-679-1896
or mail to E.P.O.N.A., PO Box 315, Epping, NH 03042-0315.