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Last Chance Animal Rescue

8500 Bensville Rd
Waldorf, MD 20603

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Adoption Application

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The undersigned hereby makes an application to be considered as an Adopter or Foster of an equine (defined as a horse, pony, donkey, or mule) from Last Chance Animal Rescue, Inc. (hereinafter, “LCAR”), a 501(c)3 charitable, rescue organization located in Charles County, Maryland by truthfully providing information on this Pre-Adoption/Fostering Application.
Today's Date
MM slash DD slash YYYY
Anticipated Acquisition Date
MM slash DD slash YYYY
Applying as
- Adopter
- Foster
Which horse are you interested in?
PLEASE TELL US ABOUT YOURSELF
Legal Name
First Middle Last
Legal Name of Spouse/Partner
First Middle Last
Your Email*
Over the age of twenty-one (21) years
- Yes
- No
Date of Birth
MM slash DD slash YYYY
Date of Birth of Spouse/Partner
MM slash DD slash YYYY
Cell Phone
Spouse/ Partner’s Cell Phone
Spouse/ Partner’s Email
Address
Street Address Address Line 2 City State ZIP Code
Mailing Address
Street Address Address Line 2 City State ZIP Code

(if different)
Employers Name
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employer Phone Number
How long have you worked there?
Spouse/Partner Employer's Name
Spouse/Partner Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Spouse/Partner Employer Phone
How long have they worked there?
Have you or any one in your household ever been convicted of animal cruelty?
- Yes
- No
If "yes", please provide date(s), Jurisdition(s), and details.
PLEASE PROVIDE INFORMATION RELEVANT TO HORSE OWNERSHIP AND/OR ACTIVITIES
Do you currently own equine?
- Yes
- No
If “yes,” please describe how many, what breed(s), type(s), and age(s).
Ever owned an equine prior to this?
- Yes
- No
If “yes,” date acquired & for how long
If “no,” how do you plan on acquiring the knowledge and skill to care for this equine?
Do you considered yourself to be
- New to equine ownership
- Novice/Limited Experience
- Substantial Experience
- Expert
Is this equine for your own use or for a minor child?
- Own use
- For a Child
If for minor Child, is the Child
- New to equines
- Novice/Limited Experience
- Currently taking riding lessons
- More than 2 yrs of lessons
What are your intended uses for an equine?
- Sanctuary care only
- Pleasure or trail riding
- Sport or Competition
- Lesson Program
If "lesson program", please explain
Are there other animals on the property where the Equine will reside?
- Yes
- No
If "yes"
- Horse or other Equines
- Other Livestock
- Dogs
- Cats
- Poultry/Fowl
Other animals on the property?

PLEASE PROVIDE INFORMATION RELEVANT TO CARE OF YOUR EQUINE
Name of Veterinarian
Phone
Email
Name of Farrier
Phone
Email
Will the Equine be living on your property?
- Yes
- No
Number of pastured acreage
Type of fencing
Type of shelter(s)
Name of Boarding Facility
Location
Phone
Contact Person
PLEASE GIVE BOARDING HISTORY (LAST 3 YEARS)
Current Boarding Facility’s Name
Street Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Operated by (name of owner/manager)
Phone
# of Years at boarding facility
PLEASE LIST YOUR REFERENCES
Please list persons familiar with your current or past handling of and involvement with horses.

Three References (may include equine trainers, instructors, professionals, or personal)
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Relationship
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Relationship
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Relationship

I hereby apply to adopt or foster an equine from LCAR upon the set terms and conditions set forth in the Adoption/Foster Agreement. As an inducement to LCAR to accept this application, I agree to provide a deposit of funds and, further, I warrant that all statements above set forth are true; however, should any statement made above be a misrepresentation or not a true statement of facts I accept that I may be rejected as an Adopter or Fosterer. Additionally, I understand LCAR is not obligated to provide any reason(s) for such rejection and shall not disclose the confidentiality of any persons contacted in seeking background information.
AUTHORIZATION: Release of Information and Investigation of Facilities
I recognize that as a part of the procedure for processing my application, information will be obtained through personal interviews with others with whom I may be acquainted. This inquiry may include information as to my character, general reputation, and personal characteristics.

I agree to permit an investigation of my current and/or prior boarding arrangements (which may include an on-site visit) and listed references for the purposes of determining my acceptance as an Adopter or Fosterer of an equine. I agree not to hold LCAR or any individual involved in the investigation liable for any perceived or real causes of action, including, but not limited to, defamation of character.
AGREEMENT TO EXECUTE AN ADOPTION CONTRACT
In the event I am approved for adoption or fostering, I agree to execute an adoption/fostering contract detailing the terms and conditions for adopting or fostering an equine from LCAR, including but not limited to, price, delivery, ownership rights, and guidelines.
The above information, to the best of my knowledge, is true and correct. I agree to permit LCAR to investigate the information and representations I have made known. If LCAR discovers any information to be false or misleading, I understand I will be denied the opportunity to adopt or foster an equine.
Full Name as Signature
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Last Chance Animal Rescue, Inc. is a 501(c)(3) nonprofit organization with a mission to minimize the euthanasia of homeless pets through both adoption and providing low-cost, high-quality spay/neuter for both dogs and cats. Our CFC number is 69822.

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