PLEASE RETURN TO: - Arabian Rescue



PLEASE RETURN TO:

The Arabian Rescue Mission

42 Glen Road

Colesville, NJ 07461

geldings@

Studs to Buds Program

Application for Gelding Assistance

Individual Y/N Organization Y/N TIN/EIN#:

Organization Name: ______________________________________________

Name: Title:

Address:

Email: Ph:

Horse(s) to be gelded:

Name: Age: Breed:

Name: Age: Breed:

Name: Age: Breed:

Name: Age: Breed:

Number of Horses Owned (by sex): M _____ G _____ S _____

Veterinarian Information:

Name: Phone #: _________________________________

Address:

Will you be using Animal Hospital of Sussex County or your vet: __________

Have you ever been charged with any animal cruelty or neglect (even if not convicted) or had any animals removed from your care? If yes, please explain the circumstances on a separate sheet. ________

Annual Income: _____________ Rescues/Annual Expenses: _____________

Please explain the circumstances under which you acquired this horse or why you want him gelded:

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Amount Requested if surgery required: $______________________

Terms of Agreement:

By signing this application you are agreeing to the terms of this program and release Arabian Rescue Mission and/or its agents from any liability arising from this action. ______ Initial

Submission of an application does not guarantee a payment of funds. If approved, payment will be made directly to the veterinarian providing the service. _______ Initial

ARM reserves the right to rescind approval if applicant information is found to be misrepresented or the best interest of the horse(s) is not served. Repayment of funds paid will be required if the horse is not being cared for adequately, misrepresentation of application information is found after funds are released or the castration was not performed. ______ Initial

Photos of the horse served will be required at 3 months, 6 months and 1 year after castration. Signature also serves as written permission for any medical records from your veterinarian be released to ARM on request. _______ Initial

ARM reserves the right to use any photos, statements or information regarding the horse helped on any media it sees fit. _________ Initial

If payment is for a rescue, we request that acknowledgment of help from ARM be stated on any media sites, FB, websites, forums, publications, etc that the organization posts on or sends out. ________ Initial

I have read and initialed the terms of this agreement and agree to all in its entirety.

Signature of Applicant:

Signature

Address

Date

DISPOSITION OF APPLICATION:

Funds Dispersed: _____________ Payee: ____________________

Approved by: _________________Date: ______________________

Signature: ______________________________________________

Funding and Application Guidelines

Arabian Rescue Mission, Inc. is a 501(c)3 non-profit. We accept applications from individuals, at least 18 years of age, and rescues. Any rescue applying must be either a 501(c)3 or registered in the state the horse is located in. Applications will be accepted while funds are available.

Assistance will be provided for gelding/castration at a rate of $100.00 per horse, paid directly to the veterinarian providing the service. Special dispensation may be given for surgery when required and as funds are available.

Please answer each question and attach the supportive documents required, as listed below:

Completed, signed, application

Photo of horse(s)

Estimate from veterinarian

IRS determination letter or copy of state registration

Once your application is completed and signed it can be scanned and emailed to geldings@ or mailed to Arabian Rescue Mission, 42 Glen Rd, Colesville, NJ 07461.

Once an application is approved an ARM representative will contact you with the decision of the committee. Normally this will be within 30 days of receipt.

You are responsible for making the appointment with the veterinarian and providing the voucher to him/her when payment is required.

Your veterinarian can then contact ARM for payment of the approved amount.

For Individuals: An itemized receipt must be provided to ARM within 14 days of the castration, showing a Zero (0) balance.

For Rescues: An itemized receipt must be provided to ARM within 7 days for the castration performed, showing the horse's name(s).

Photos of the assisted horse should be submitted will be required to be submitted to ARM at 3 months, 6 months and 1 year after assistance is provided.

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