I/We, the undersigned, hereby IRREVOCABLY surrender and relinquish to

SECOND CHANCE FOR HORSES RESCUE, the following equine (s):

Name:___________________________________________________________________________

Registered Name: _________________________________________________________________

Registry: ___________________________ Registration No.______________________________

(Please attach registration papers)

Identification (tattoos or brands) ______________________________________________________

Color and Markings: _______________________________________________________________

Rideable: Yes______ No ______

Discipline ________________________________________________________________________

Aggressive: Yes ______ No ______

If yes, please explain:_______________________________________________________________

Vices:___________________________________________________________________________

Shots received within the last 12 months:_______________________________________________

________________________________________________________________________________

Feeding schedule (what and when): ___________________________________________________

Special needs: ____________________________________________________________________

Major medical issues (within the last 3 years): ___________________________________________

________________________________________________________________________________

Other comments: _________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Representations and Warranties:

I/We hereby represent and warrant to SECOND CHANCE FOR HORSES RESCUE, their agents, successors and assignees, that the undersigned is/are the sole owner(s) of the above described equine(s). That I/we have full power and authority to surrender this/these animal(s) for adoption; that I/we am/are the only person(s) or organization/corporation who is/are listed as registered owner(s) of this animal; that no other person or person’s signature is/are required to effect a valid transfer of ownership and registration papers on this animal (if available); and that no other person or persons has/have any legal or equitable ownership interest in this/these animal(s).

Delivery of Registration (if available)

I/We agree contemporaneously with the execution of this document to deliver to SECOND CHANCE FOR HORSES RESCUE a properly signed transfer of all registration papers for the above-described equine(s), omitting the name of the transferee.

Other Pertinent Information

I/We also agree to provide SECOND CHANCE FOR HORSES RESCUE with any documents and all other available information concerning this/these equine(s) which might assist in matching this/these equine(s) with the proper prospective adoptive home, including health and immunization records, pedigree(s), name(s) and address(es) of breeder(s) or other person(s) from whom the equine(s) was/were acquired, and information concerning this/these equine’s history, such as important life events and individual personality traits.

Surrender of Rights

By executing this document, I/we understand that I/we are giving up forever all rights to, titles to and interests in the above equine(s) and I/we further understand that all future decisions regarding the placement of this/these animal(s) will solely be those of SECOND CHANCE FOR HORSES RESCUE. I/We also understand that if this/these equine(s) is/are later found to have an unpredictable temperament unsuitable for any placement, or if the animal’s quality of life is substantially impaired, in the opinion of a competent veterinarian, by chronic, irreversible, painful condition, euthanasia may be considered as an alternative to adoption.

Release and Indemnity

I/We, the undersigned, hereby specifically and forever release and hold SECOND CHANCE FOR HORSES RESCUE harmless from any and all liability arising from the placement for adoption by SECOND CHANCE FOR HORSES RESCUE of the above-mentioned equine(s), or for any other actions taken by SECOND CHANCE FOR HORSES RESCUE in accordance with, and in reliance on, the representations I/we have made, and the authorizations I/we have provided under the terms of this document. I/We agree to indemnify and hold harmless SECOND CHANCE FOR HORSES RESCUE for any damages suffered and expenses incurred, including legal fees, in defending any legal

action, whether for bodily injury or death, property damage, breach of contract, or otherwise, whether instituted by us or by any other person or persons, including the adoptive owners arising out of, or in consequence of the placement of this/these equine(s), in reliance on the authorizations, representations and warranties I/we have made in this agreement.

I/We understand that SECOND CHANCE FOR HORSES RESCUE will make every effort to find a suitable home for my/our equine(s) following its normal adoption procedures, with certain exceptions (ie: those that must be euthanized upon recommendation of a licensed veterinarian). I/We hereby surrender all rights, titles and interests in the above-referenced equine(s) voluntarily and without coercion or threats of any kind.

THIS IS A LEGALLY BINDING DOCUMENT FOR THE IRREVOCABLE SURRENDER OF MY/OUR EQUINE(S) FOR PLACEMENT IN AN ADOPTIVE HOME. PLEASE READ THIS DOCUMENT CAREFULLY AND COMPLETELY BEFORE SIGNING. TAKE AS MUCH TIME AS YOU NEED TO FULLY CONSIDER THIS IMPORTANT DECISION. IF YOU HAVE ANY QUESTIONS, PLEASE CALL (954) 573-5718.

I/WE HAVE READ THE PRECEDING AND AGREE TO ALL CONDITIONS SET

FORTH THIS ______ DAY OF ___________ IN THE YEAR________.

Signature(s):___________________________________________________________________

Print name(s):__________________________________________________________________

Address:______________________________________________________________________

Business name (if applicable):_____________________________________________________

Telephone number:______________________________________________________________

Witnessed by (signature):_________________________________________________________

Print name:____________________________________________________________________

Address:______________________________________________________________________

Business name (if applicable):_____________________________________________________

Telephone number:_____________________________________________________________