Bright Futures Farm

44793 Harrison Road

Spartansburg, PA  16434

Phone: 814.827.8270

 email:info@brightfuturesfarm.org

RECORD RELEASE

DATE: __________

Reference:  Please complete the following information to the best of your ability.  Please be as honest as your knowledge permits regarding the questions you are about to answer.  Our horses are members of our family, and we strive to find the right home for each of them. 

All information remains strictly confidential – unless YOU choose to provide a copy to the applicant prior to returning this form to us.  We do not share this information with the applicant, but we do use it in conjunction with other information the applicant has provided to ensure that we know this person is knowledgeable and proactive when it comes to the welfare of their animals.

Please mail your completed reference questionnaire to

Bright Futures Farm

Attn:  References

44793 Harrison Road

Spartansburg, PA  16434 

ADOPTION APPLICANT___________________________(full name)

 YOUR NAME________________________________________

YOUR OCCUPATION (FARRIER OR VETERINARIAN) ___________________________________________

PHONE NUMBER__________________________________EMAIL ADDRESS______________________

ADDRESS OF YOUR PRACTICE/BUSINESS___________________________________________________________

                                                ___________________________________________________________

HOW LONG HAVE YOU KNOWN APPLICANT____________________

WHEN IS THE LAST TIME YOU SAW THE APPLICANT IN PERSON REGARDING A PET [OF THEIRS]_______________________

WHEN IS THE LAST TIME YOU SPOKE WITH THE APPLICANT REGARDING A PET [OF THEIRS] __________________________

IF YOU ARE THE APPLICANT’S VETERINARIAN, HAS THE APPLICANT PROVIDED YOU WITH A SIGNED COPY OF OUR RECORD RELEASE FOR YOUR FILES? _________

 PLEASE CHECK ALL THAT APPLY…

1.  ___I HAVE SEEN APPLICANT INTERACTION WITH THEIR OWN PETS (CIRCLE ALL THAT APPLY)

FEEDING      GENERAL CARE        TREATMENT OF ILLNESS         RIDING

2.  CIRCLE ONE…

 I BELIEVE THAT APPLICANT PROVIDES ADEQUATE CARE / ABOVE AVERAGE CARE / STELLAR CARE   FOR THEIR PETS (I.E.  SAFE AND SECURE SHELTER, CLEAN TROUGHS, AMPLE FOOD, REGULAR GROOMING/MAINTENANCE, ETC.)

 3.  I HAVE SEEN THE APPLICANT’S STABLING AND PASTURE FACILITIES, AND I WOULD MAKE THE FOLLOWING STATEMENT REGARDING    THE SAFETY OF THE ENVIRONMENT (EXAMPLE:  NO OBJECTS IN THE AISLEWAY OR IN HORSE WALKING AREAS THAT COULD CAUSE INJURY IF THE HORSE SPOOKED OR SOMEONE WASN’T PAYING ATTENTION… STALLS AND/OR RUN IN SHED(S) IN GOOD STRUCTURAL CONDITION…LOOSE BOARDS REPAIRED IN A TIMELY MANNER… PROTRUDING NAILS REMOVED OR RE-SUNK IN A TIMELY MANNER, ETC…  PASTURE FENCING IS SECURE AND REPAIRS APPEAR TO BE MADE IN A TIMELY MANNER, NO INJURY CAUSING OBJECTS ARE LYING ABOUT…ETC.):

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5.   PLEASE CHECK ALL THAT YOU CAN KNOWLEDGEABLY ANSWER …

___THE HOME AND BARN/STABLING/PASTURE AREA APPEARS TO BE KEPT CLEAN

___THE APPLICANT APPEARS TO HAVE THE TIME AVAILABLE TO SPEND AT LEAST HALF AN HOUR A DAY WITH THEIR NEW HORSE

WHICH OF THE FOLLOWING TWO STATEMENTS BEST DESCRIBES THE APPLICANT, BASED UPON YOUR KNOWLEDGE

___I KNOW THAT WHEN ONE OF THE APPLICANT’S PETS IS ILL, HAS A MISSING SHOE/HOOF ISSUE OR IS INJURED, THE APPLICANT IS PROACTIVE IN TREATING THE ANIMAL,  AND CALLS THE VET OR FARRIER WHEN NECESSARY WITH NO DELAY

___I KNOW THAT WHEN ONE OF THE APPLICANT’S PETS IS ILL OR INJURED, THE APPLICANT MAY WAIT TO SEE HOW THE ILLNESS OR INJURY MANIFESTS ITSELF BEFORE CALLING THE VET, BUT THE APPLICANT DOES THEIR BEST ON THEIR OWN TO MAKE THE PET COMFORTABLE UNTIL THEY MAKE THAT DECISION.

___I KNOW THAT THE APPLICANT KNOWS THEIR LIMITATIONS WITH REGARD TO WHAT TYPE OF HORSE HE/SHE IS CAPABLE OF HANDLING AND RIDING, AND THAT THE APPLICANT USUALLY BASES THEIR DECISIONS ON FACT RATHER THAN ON EMOTION.

___I BELIEVE THE APPLICANT TO BE AN HONEST PERSON, AND HAVE NEVER KNOWN THE APPLICANT TO LIE OR STRETCH THE TRUTH

___I BELIEVE THE APPLICANT IS A SELF-LESS PERSON AND PUTS THE WELFARE OF OTHERS, INCLUDING THEIR PETS, AHEAD OF THEIR OWN (I.E. IF THE APPLICANT ISN’T FEELING WELL, OR THE WEATHER IS HORRIBLY INCLEMENT, …WOULD THE APPLICANT GO TO THE BARN TO CARE FOR THEIR HORSES RATHER THAN SAY “THEY’LL BE OKAY FOR ONE DAY WITHOUT ME”)

 _________________________________________DATE:________________

Reference

Thank you in advance for taking time to complete this form