Vet

            East Texas Horse Rescue and Sanctuary
                    12292 State Highway 21 East
                              Alto, Texas 75925


                          Veterinary Reference Form

Adopter / Foster applicant:
Name___________________________________________________________
Address_________________________________________________________
City, State, Zip
_______________________________________________________________
Phone __________________________________ Cell ____________________

This form is an attempt to insure that the above named applicant will have a
veterinarian available to care for their adopted Equine.
If you do not have a current veterinarian, please ask the veterinarian who
will be working on the Equines(s) that will be in your care to fill out this form.

Veterinarian:
Name___________________________________________________________
Address_________________________________________________________
City, State, Zip____________________________________________________
Phone _______________________
Have you worked on the applicants animals before ? Y N
If no, are you willing to work with equines in his /her care? Y N
If yes, does he/she keep their equines current on vaccinations? Y N

Tell us about the care and condition of the equines in his/her care now:

Would you recommend this person as adoptive home for East Texas Horse
Rescue and Sanctuary ?   Y N

Signature of veterinarian:                                                Date:

___________________________________________________________