Wild Horses In Need, Inc.

15 Flanigan - Star Route

Reno, Nevada  89510

(775)677-7262

Adoption Application

Name (Last First,M.I.)

Street Address (required)

City/State/Zip

Drivers Lic. / State / Exp.

Home Phone(area code first)

Bus. No.

Number of animals requested:

Please answer the following questions:

1. Location horse/s will be kept:(if different from your own, please provide letter stating that no liens will be put on horses)

2. Have you read and do you understand the PROHIBITED ACTS and the TERMS OF MAINTENANCE AND CARE AGREEMENT?____yes____no

3. Facility information:(if out of state, please provide statement from local Vet. about facility)

(a) Shelter size,height,and construction materials:

(b) Pasture or corral, size, fence height, and construction material:

(c) How is water provided:

(d) Type and amount of feed to be provided:

4. Will you or someone else transport the animal/s, please describe trailer to be used:

5. Have you previously adopted from any agency(B.L.M./other) in the past:

If yes, please provide date and location:

6. Have you ever been convicted of abuse or inhumane treatment of animals, violation of the WILD FREE ROAMING HORSE AND BURRO ACT or the WILD HORSE AND BURRO REGULATIONS?___yes___no

Signature of Applicant

Date

FOR OFFICE USE ONLY

Application____Approved____Disapproved (state reason below)

Authorized Signature

Date