PLEASE TYPE YOUR ANSWERS IN, THEN PRINT.

For the purpose of this agreement, herein the adopting party is referred to as the Licensee.

LICENSEE�S� FULL NAME:

STREET ADDRESS (AND PO BOX):

CITY, STATE, ZIP CODE:

HOME TELEPHONE NUMBER:

HOME E-MAIL ADDRESS:

WORK TELEPHONE NUMBER:

WORK E-MAIL ADDRESS:

FAX NUMBER:

DRIVER�S LICENSE� NUMBER:

STATE:

REGISTRATION NUMBER, IF APPLICABLE:

HORSE:

BREED:

AGE OF HORSE:

COLOR:

SEX:

CONDITION OF THE HORSE:

INTENDED USE OF THE HORSE:

1.        Consideration.� In consideration for the above-stated license fee, payable upon execution of this adoption agreement, E.P.O.N.A. grants a license to the above-named for the custody and care of the above-described horse, and the licensee agrees to accept and care for said horse, under the following terms and conditions.

2.        License with right of termination.� Licensee understands that the said horse must receive appropriate care and handling for its lifetime, as deemed acceptable by E.P.O.N.A. and the State Equine Laws of New Hampshire and Massachusetts.� At such a time as the said horse is maintained in a manner not acceptable to E.P.O.N.A., this license shall terminate immediately, and the licensee agrees to surrender the said horse immediately to E.P.O.N.A. upon demand.

3.        Disclosure.� E.P.O.N.A. hereby discloses any injuries, blemishes, unsoundness, or pre-existing conditions known to E.P.O.N.A.

 

Licensee Initials __________

 

CONTINUE TO PAGE 2 OF THE ADOPTION AGREEMENT.