This form identifies the horse that I have provided for in my will with the understanding that, if the horse survives me, the Horse Protection Society of BC (HPS) will make every reasonable effort under its Equine Survivor Program to see to the care of my horse according to my wishes.  (Please complete a separate form for each horse being registered with the Equine Survivor Program.)


 Horse’s name (registered and/or barn names):_________________________________

Description of horse, including distinguishing features: ______________________________________________________________________

______________________________________________________________________

Veterinarian’s name and contact info: _______________________________________

______________________________________________________________________

Farrier’s name and contact info: ____________________________________________

______________________________________________________________________

Medical history (please describe any significant issues that would affect the care of your horse): _________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Dietary requirements: _____________________________________________________

_______________________________________________________________________

Disposition/temperament:Is the horse well mannered in the following situations?

(check all that apply)

Handling ___ feeding ____ driving ____ riding ____ catching ____ trailering ___ farrier ___ vet___

Describe any situations in which the horse may be hard to handle or have behaviour problems, such as cribbing, weaving, pacing, rearing, bucking, biting, aggression, etc.

________________________________________________________________________

Best uses (what do you think would be the best use for your horse?):

________________________________________________________________________

Special instructions/wishes: _________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Name and contact information for your executor(s): ______________________________

________________________________________________________________________

________________________________________________________________________

Name and contact information for your lawyer: _________________________________

________________________________________________________________________

I confirm that I have made provision in my will for the bequest to HPS of my horse identified above, and provided for a donation to HPS of at least the required minimum amount, all as set out in the Program Summary for the HPS Equine Survivor Program.  I acknowledge and understand that HPS will arrange for the care of my horse in its sole discretion in accordance with the Program Summary.

                                                                                  Attach picture of your horse below (optional):

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Signature of Owner

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Name of Owner

________________________________

________________________________

________________________________
Address of Owner

Completed forms can be mailed to Horse Protection Society of BC, 4370 224th Street, Langley, BC  V2Z 2V5.