CKRH Trial Horse Application
Owner Information
Owner First Name
Owner Last Name
Phone Number
Email
Address
How did you hear about the trial horse/free-lease program?
Horse Information
Name of horse/pony
Registered Name (if applicable)
Age
Gender
Please select...
Gelding
Mare
DOB (mm/dd/yyyy) if applicable
Breed
Is your horse gaited?* *CKRH is only accepting non-gaited horses at this time*
Height (in hands)
Is your horse 100% sound at the walk/trot? *CKRH is only accepting 100% sound horses at the 2 gaits (bonus if sound at the canter)*
Build
Please select...
Light
Average
Heavy
Is your horse able to be ridden by a rider ages 2-90? Explain.
Would you like to donate or free lease your horse to CKRH and why? (please state your preference if you have one)
CKRH is currently only wanting free-leased horses (could be willing to take a donation for the perfect horse) as we want to ensure the horses have a home once their job here is done. By signing my full name below, I acknowledge the terms and conditions of this agreement. If for any reason this is not possible, please write N/A
Farrier work, all of our feed, and other means of care are donated to us by our local community partners. With your free lease would you be willing to pay for all or any extraneous medical expenses, podiatry work that isn't donated, etc should it be needed?
If, after evaluation, the horse is determined to be a candidate for trial are you willing to allow the horse to come to CKRH for a 90-day trial period?
Please select...
Yes
No
How long have you owned this horse and how did you acquire him/her?
Please upload a side view of the horse/pony
Please upload a headshot of the horse/pony
General Care and Health
Does this horse have any past/present medical conditions or on any special medications/supplements?
Yes
No
If you answered yes above, what are they?
Has this horse ever foundered?
Yes
No
Has this horse ever shown signs of colic?
Yes
No
If you answered yes above, what kind?
Is this horse walk/trot/ sound?
Yes
No
Does he/she have any limitations?
Does this horse have any history or current issues with lameness, injury, arthritis, or surgeries? Joints injected?
What type of boarding is the horse currently in? (select all that apply)
Stalled 24/7
Pasture Only
Pasture/Stall
Dry lot in summer/spring
Other
What are this horse's feed requirements (ie. what type/brand and how much)? Any feed/forage restrictions?
What types of fencing has this horse been kept in? (select all that apply)
3-plank wood
Electric tape
Steel pipe
T-post or barbed wire
Other
How is this horse to catch in the fields? What is your process?
Does this horse need shoes?
Yes
No
If you answered yes above, what kind?
When was this horse last dewormed and what product was used?
When was this horse last vaccinated? What vaccinations were received?
When did this horse last see the farrier?
Has this horse had a negative coggins test?
Yes
No
If you answered yes above, when?
Disposition
What is this horse's attitude towards others? Strangers?
What rank is this horse with other horses?
Dominant
Middle
Low
Does this horse bite people or other horses?
Please select...
Yes
No
Other
Does this horse exhibit any of the below vices? (select all that apply)
Cribbing (CKRH has a no cribbing policy- if a horse has a history of cribbing or is seen cribbing at any time, CKRH reserves the right to send the horse immediately home)
Wind Sucking
Wood Chewing
Nibbling
Stall Weaving
Pacing
Excessive Pawing
Other
None
Does this horse kick when another horse approaches from behind?
Please select...
Yes
No
Other
Is this horse herd bound?
Please select...
Yes
No
Other
Does this horse have issues with separation anxiety?
Please select...
Yes
No
Other
Does this horse mind being in a stall?
Please select...
Yes
No
Other
Training and Experience
My horse can..... (select all that apply)
Horse tie
Cross tie
Ground tie
None of the above
My horse has been exposed to..... (select all that apply)
Cows
Bicycles
Fireworks/gunshots
Runners
Large Crowds
Dogs/Cats
Utility Vehicles/Tractors
None of the above
How are this horse's ground manners when leading? (Select all that apply)
Pushy
Quick
Slow
None of the above
Stays with leader
Haven't tested
What type of riding and other activities have you done with this horse?
What did this horse do before you owned him?
When was the last time this horse was ridden and how often are they worked?
What level rider can handle this horse? (Select all that apply)
Beginner
Intermediate
Advanced
Does this horse trailer?
Please select...
Yes
No
Has your horse done any of the following? (Select all that apply)
Trail Riding
Ridden by children
Pony Club
Jumping
Lunging or Long lining
Natural horsemanship training
Ridden bareback
Trot over poles or cavaletti
Driving
Round penning
Mounted police training
Shown
Which of the following riding maneuvers is your horse familiar with? (Select all that apply)
Direct rein or Neck rein
Walk/Trot/Canter on loose rein
Go into a frame or work collected
Halt squarely
Turn on the forehand or haunches
Side pass
Shoulder in/shoulder out
Trot or Jog
Walk/Trot/Canter with contact
Back up
Pick up canter leads consistently
Leg yield
Flying lead changes
Tack
How is this horse while saddling and bridling? (Select all that apply)
Docile
Girthy
Refuses bit
Easy to bridle
Fidgity
Kicks out
Bites
I don't use a saddle or bridle
How is this horse's manners while grooming and picking hooves? (Select all that apply)
Picks up all 4 hooves
Agitated
Docile
Fidgity
Mouthy
Other
Type(s) of saddle used (if none, put N/A)
Type(s) of pad used (if none, put N/A)
Type(s) of bridle used (if none, put N/A)
Type(s) of bit used (if none, put N/A)
Type(s) of other tack used (if none, put N/A)
Trial Information
According to CKRH policy, the owner (or someone acting on the owner's behalf) must ride the horse in front of CKRH evaluators before the evaluators may ride.
Please understand that we may not give your horse a fair evaluation if we must also supervise small children. Please make arrangements for children prior to your horses evaluation. Thank you. By typing your full name below, you acknowledge that you have read and understood these terms.
If we decide to bring your horse in for a 90-day trial, we
request that owners provide their own transportation
for that horse to our facility. If this is absolutely not possible, please notify the Equine Manger to investigate other options. By typing your full name below, you acknowledge that you have read and understood these terms.
Horses leased to the program can be ridden by CKRH staff and participants only. Horse owners and volunteers are not permitted to ride during the leasing period due to the equine usage and training protocols of the organization. By
typing your full name below, you acknowledge that you have read and understood these terms.
Horse owners may visit their horses at any time so long as the Equine Manager is notified to ensure the visit will not impact a participant’s riding lesson. Upon the first visit, owners are required to sign a visitor liability agreement before interacting with horses or participants.
By
typing your full name below, you acknowledge that you have read and understood these terms.
If we decide to evaluate your horse is there an open field, pasture, ring/indoor arena or another area where we may ride? Outdoor or Indoor?
Owners availability for initial trial visit (please list days and times within a 2 week period that you are available)
Location of Horse/Pony and Directions (please include road conditions)
Contact Information