Equine Assistance Application Form

These grants are for PRIVATE EQUINE OWNERS ONLY who are needing assistance.

If you're requesting assistance for multiple equines, please complete a separate application for each one.

Grants are awarded for equines only, defined as: horses, donkeys, mules, hinnies, ponies, zebras, zebroids.

Three photos of the equine benefiting from the grant (one of each side and one of their face) is required for identification purposes.

Which grant are you applying for?

First name

Last name

Address

Phone

Tell us why you need financial assistance

Equine's Name

Breed

Colour

Sex

Age

How long have you owned this equine?

What are the reasons this equine needs humane euthanasia (ie. health or behavioural problems)?

Are veterinarian records available?

Photos of the equine (3 total - one of each side and one of the face)

Approximate date of procedure

Name of Veterinarian Office/Clinic

Name of veterinarian who will perform the procedure

Mailing Address of Veterinarian Office/Clinic

Phone Number of Veterinarian Office/Clinic

Email Address of Veterinarian Office/Clinic

Authorization and Release: I agree to provide pictures, videos, invoices and other documentation, as needed, to satisfy terms of receiving a grant from Horse Aid Canada.

Media Release: I agree to allow Horse Aid Canada to use photos, videos and information about the equine(s) for which I am receiving a grant at their discretion for the purpose of raising awareness for their grant programs with the goal of helping more equines.

Health Records Release: I authorize the release of any available healt

Signature

Signature field is empty.

Date of signature