Horse Donation Agreement - Savannah Station Therapeutic Riding

SAVANNAH STATION THERAPEUTIC RIDING PROGRAM
Mailing:
P.O. Box 852084
Yukon, OK 73085
Physical:
9304 N. U.S. Hwy 81
El Reno, OK 73036
HORSE DONATION POLICY & PROCEDURES
Policy
Thank you for considering a donation of your horse to the Savannah Station Therapeutic Riding
Program. It is the policy of S.S.T.R.P. to accept donations of horses from their owners for the purpose of
our Therapeutic Program. Horses accepted into S.S.T.R.P.’s program must be mentally and physically
healthy and sound, and they must be able to maintain a moderate work schedule. S.S.T.R.P is not a
sanctuary for retired horses, nor a rescue organization, but rather a special place where a special type of
horse fills a special need.
Procedures
1. Upon receipt of the completed Horse Donation Application, S.S.T.R.P.’s Program Coordinator
and Barn Manager will review the application.
a. If it is determined that the horse may not be a good therapy horse candidate, the owner
will be notified and it will be explained as to why we believe the horse may not work for
the program.
b. If the horse is deemed to be a potential therapy horse candidate, the Program
Coordinator and Barn Manager will schedule an evaluation to view and test the horse at
its present location.
2. During the evaluation visit, we request that:
i. The owner demonstrates or has someone demonstrate how the horse moves
under saddle at all gaits
ii. The horse must be current on all dental, shots, deworming, hoof care, and have
a current negative coggins. (Copies of the records will need to be made
available to our staff.
iii. The owner demonstrates how the horse loads and unloads from their trailer (if
available).
iv. The S.S.T.R.P. Program Coordinator and Barn Manager will perform ground and
under saddle testing to determine temperament, training, and suitability in the
therapy setting.
a. In the event that the horse does not pass the evaluation, the owner can reapply at a later time.
S.S.T.R.P.’s program will be growing and expanding into other areas and it may be possible that
the horse that is unsuitable for therapy may be suitable in another aspect of the program.
b. If the horse passes the evaluation, he/she may enter the S.S.T.R.P. 90 day evaluation period.
i. At that time, the owner will sign a 90 day lease for the horse and provide copies
of all medical records, shoeing records, and feeding requirements.
ii. The owner will transport the horse to S.S.T.R.P. (if possible).
iii. If the horse is on a special feed, supplement, or medication, the owner will
provide enough of the feed or supplement to last the 90 day period.
3. If at any time during the 90 day evaluation period, the horse is determined to be unsuitable for
therapy or S.S.T.R.P. isn’t a good fit for the horse, the owners will be contacted and the horse
returned to them.
4. If the horse is determined to be suitable and a good fit for the program, a donation contract will
be signed and ownership of the horse will transfer to S.S.T.R.P. If the horse needs to retire from
therapy work, the owner will get first right of refusal to take the horse back.
Rev. 1/17/17
SAVANNAH STATION THERAPEUTIC RIDING PROGRAM
Mailing:
P.O. Box 852084
Yukon, OK 73085
Physical:
9304 N. U.S. Hwy 81
El Reno, OK 73036
HORSE DONATION APPLICATION FORM
Please fill out the following form completely if you are interested in donating your horse or pony to
Savannah Station Therapeutic Riding Program.
In addition to this form, please submit at least one photograph of your horse/pony.
Owner Information
Owner Name: _________________________________________________________________________
Address: _____________________________________________________________________________
Home Phone: _________________ Cell Phone: __________________ Work Phone: _________________
Email: ________________________________
Horse/Pony Information
Horse/Pony Name: _____________________________________________________________________
Horse/Pony Breed: _____________________________________________________________________
Horse/Pony Color: _____________________________________________________________________
Horse/Pony Age: _________ Height: _________ Weight: _________ Gender: Mare Gelding Stallion
How long have you owned this horse/pony? _________________________________________________
Why have you decided to donate this horse/pony to Savannah Station Therapeutic Riding Program?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Current Location: ______________________________________________________________________
Training Experience
Past training/experience: ________________________________________________________________
Showing/Competition Experience
Showing/Competition Experience: Yes No
If yes, please elaborate or attach record if available:
_____________________________________________________________________________________
_____________________________________________________________________________________
Rev. 1/17/17
SAVANNAH STATION THERAPEUTIC RIDING PROGRAM
Mailing:
P.O. Box 852084
Yukon, OK 73085
Physical:
9304 N. U.S. Hwy 81
El Reno, OK 73036
Can this horse be ridden by: (check all that apply)
___ Children at walk
___ Light/Medium weight riders (walk & trot)
___ Adults at walk & trot
___ Anyone (walk, trot, and canter
Is this horse easy to: (check all that apply)
___ Catch/Halter
___ Lead
___ Saddle
___ Bridle
___ Tie/Cross Tie
___ Groom/Clip ___ Clean Hooves
___ Load/Unload in Trailer
___ Worm
___ Bathe
Does the horse: (check all that apply)
___ Direct Rein
___ Neck Rein
___ Stand quietly for mounting/dismounting
Has this equine been trained or had experience in: (check all that apply)
___ Trail
___ Driving
___ Dressage ___ Competitive Trail
___ Eventing
___ General Western Riding
___ Endurance ___ Barrel Racing ___Reining
___ General English Riding
___ Jumping
___ Youth
___English Pleasure
___Western Pleasure
___ Other: ___________________________________________________________________________
Is this equine currently suitable for or have the potential for: (check all that apply)
___ Trail
___ Driving
___ Dressage ___ Competitive Trail
___ Eventing
___ General Western Riding
___ Endurance ___ Barrel Racing ___Reining
___ General English Riding
___ Jumping
___ Youth
___English Pleasure
___Western Pleasure
___ Other: ___________________________________________________________________________
How often is the horse currently being ridden? ______________________________________________
If not currently being ridden, why not? ______________________________________________
When was the equine last regularly ridden? __________________________________________
Temperament
Temperament: (1-10, 1= Very Quiet, 10= Highly Spirited)
________________________________
Friendliness toward Adults: (1-10, 1= Nasty/Afraid, 10= Very Friendly)
_________________________
Friendliness toward children: (1-10, 1= Nasty/Afraid, 10= Very Friendly) _________________________
Friendliness toward Horses: (1-10, 1= Nasty/Afraid, 10= Very Friendly)
Rev. 1/17/17
_________________________
SAVANNAH STATION THERAPEUTIC RIDING PROGRAM
Mailing:
Physical:
P.O. Box 852084
9304 N. U.S. Hwy 81
Yukon, OK 73085
El Reno, OK 73036
Friendliness toward Animals: (1-10, 1= Nasty/Afraid, 10= Very Friendly) _________________________
Has this equine ever: (check all that apply and explain if “yes”)
___ Bucked
___ Kicked
___ Reared
___ Bitten
___ Other improper behavior________
Trailering
Has your horse ever been transported in a horse trailer? Yes
No
If yes, what type of trailer? ______________________________________________________________
Was your horse easy to load in the trailer? Yes
No
If no, what did the horse do and how did you load him/her? ____________________________________
_____________________________________________________________________________________
Does your horse back quietly out of a trailer? Yes
No
If no, how does he/she unload? ___________________________________________________________
Care
Has your horse/pony ever been on 24 hour turnout: Yes
In the pasture, is your horse/pony:
Alpha
No
Turnout needs: _____________
Passive
Current feed: __________________________________________________________________________
Current Hay: __________________________________________________________________________
Current Supplements: ___________________________________________________________________
Current Meds: _________________________________________________________________________
Hoof care:
Barefoot
Front Shoes Only
Shoes on all 4 Special Shoes_______________
Last worming/type: _____________________________________________________________________
Last teeth floating: _____________________________________________________________________
Last vaccines: _________________________________________________________________________
Last Coggins: __________________________________________________________________________
History of Founder/Colic: Yes
No
If yes, explain: ________________________________________
Signs of Cushings or other metabolic diseases? Yes
Cribber or Weaver:
Yes
No
If yes, explain: ____________________
If yes, explain: ________________________________________
Any past injuries that required treatment from a vet?
Rev. 1/17/17
No
Yes
No
If yes, explain: ______________
SAVANNAH STATION THERAPEUTIC RIDING PROGRAM
Mailing:
Physical:
P.O. Box 852084
9304 N. U.S. Hwy 81
Yukon, OK 73085
El Reno, OK 73036
_____________________________________________________________________________________
Any pre-existing health conditions, issues, or inuries?
Yes
No
If yes, explain: ______________
_____________________________________________________________________________________
_____________________________________________________________________________________
Name of current vet: ___________________________________ Phone Number: ___________________
Name of current farrier: ________________________________ Phone Number: ___________________
Please include the name of one reference who has trained, ridden, shown, boarded or leased this
horse/pony: __________________________________________________________________________
_____________________________________________________________________________________
Is there anything else you can tell us about the horse that will enable us to better evaluate him/her:
_____________________________________________________________________________________
Mail this application to:
Savannah Station Therapeutic Riding Program
Attn: Program Coordinator
P.O. Box 852036
Yukon, OK 73085
Rev. 1/17/17
SAVANNAH STATION THERAPEUTIC RIDING PROGRAM
Mailing:
P.O. Box 852084
Yukon, OK 73085
Physical:
9304 N. U.S. Hwy 81
El Reno, OK 73036
VET CHECK LETTER
Please give this form to your veterinarian for completion.
Horse/Pony Name: _____________________________________________________________________
Owner Name: _________________________________________________________________________
Date of last dental exam/float: ____________________________________________________________
Date of last shots given and type: _________________________________________________________
Date of last dewormer given and type: _____________________________________________________
To be completed by licensed veterinarian only:
Horse’s Weight: ___________ Height: ___________
Age: ___________
Comments on:
Eyes: ________________________________________________________________________________
Back: ________________________________________________________________________________
Legs/Hooves: __________________________________________________________________________
Teeth: _______________________________________________________________________________
Overall Condition: ______________________________________________________________________
How long have you known this horse? ______________________________________________________
To the best of your judgment, do you believe that this horse would be suitable in the therapeutic riding
program at Savannah Station Therapeutic Riding Program? _____________________________________
Although we are a therapeutic riding program, all of our horses must be sound at the walk, trot, and
canter, be in good health, be able to comfortably carry 15-20% of their body weight, and be able to do
moderate work 3-5 days a week.
Veterinarian’s Name (printed): ___________________________________________________________
Signed: ______________________________________________ Date: ___________________________
Phone Number: ____________________ Practice: ____________________________________________
Mail this application to:
Savannah Station Therapeutic Riding Program
Attn: Program Coordinator
P.O. Box 852084 Yukon, OK 73085
Rev. 1/17/17