ADOPTION APPLICATION   Peaceful Mountain Horse Rescue, Inc. ("Peaceful Mountain") requires ALL applications be submitted with photographs of the pastures, fencing, barn and stalls, and any other horses/ponies at the facility where the horse/pony will be kept. Peaceful Mountain may request additional information or pictures to complete its review and may require a visit to your facility before your application will be approved. General Information Full Name: __________________________________ Age: _______ Social Security Number: ______________ Address: ____________________________________________________________________ Town: ____________________________, State: ________ Zip Code: _________ County: ______________ Telephone Number (with area code): ____________________ Email Address: _________________________________________________ Work Telephone Number: ___________________ Occupation:_______________________ Will you agree to Peaceful Mountain's requirements that a Veterinarian Certification and picture of the adopted horse/pony be submitted to Peaceful Mountain every six (6) months for five (5) years.    ________________________ Questions 1. If there is a specific horse or pony you are interested in, please state the name of that horse or pony. ________________________________________________________________ 2. Please list the name, address, and telephone number of your current veterinarian and farrier that will be caring for your horse or pony? A. Veterinarian = ____________________________________________________                               ____________________________________________________ B. Farrier          = ____________________________________________________                               ____________________________________________________ 3. What is your experience with horses? ________________________________________ ______________________________________________________________________ ______________________________________________________________________ 4. What is the intended use for this horse or pony? Please place an "X" next to all possible answers: ______ Companion (no riding) ______ Pleasure riding only ______ Trail riding ______ Jumping ______ Barrels, Poles, etc. ______ Endurance riding ______ Dressage 5. Will the horse be stabled on your own property? _________ If you answered yes to this question, please answer the following questions "a" through "c". a. If your own property, how many acres do you own? ________ b. How many pasture acres will the horse/pony have? _________ c. How many horses and/or ponies do you currently have? _________ d. Have you sold any horses or ponies in the past five (5) years? _________ a. If yes, what were the reason(s) for selling: __________________ ____________________________________________________ 6. If the horse/pony will be stabled at a boarding facility (or on someone else’s farm or property), please provide the following information: a. Name of the boarding facility (or farm)____________________________________ b. Owner’s name of the boarding facility or farm: _____________________________ c. Address of the boarding facility or farm:___________________________________ ___________________________________________________________________ d. Telephone number of the boarding facility: _________________________________ e. Total number of horses/ponies at this facility: _______________________________ 7. Whether on your property or at a separate facility, please answer the following questions: a. What type of shelter (i.e., barn, run-in shelter, etc.) will the horse/pony have? _______ _____________________________________________________________________ b. If a barn, please provide the number of stalls and the size of the stalls. _____________ _____________________________________________________________________ c. What type of fencing is used for the horse pasture? ____________________________ 8. Please list the names, addresses, and telephone numbers of two references familiar with your experience and care of horses that we may contact. 1. ____________________________________________________________________ ____________________________________________________________________ 2. ____________________________________________________________________ ____________________________________________________________________ When completed, please return to:  Peaceful Mountain Horse Rescue, Inc., 350 Hackett Road, Hampton, NJ  08827