
SAFER: Sonoma Action For Equine Rescue
Hay Assistance Program Application
Please use back of sheet if more room is needed.
Name_______________________________ Phone(s)__________________________________
Address________________________________Email ___________________________________________
Horses involved
Name Age Sex (Mare/Gelding or Stallion) Color/Markings Teeth Deworming
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___________________________________________________________________________________________________
Are other horses kept on premises that will not need SAFER Feed? If Yes how many_____________
Address where horses are kept if different from above: ______________________________________________________________
Caretaker’s Name (if different from owner) ___________________________
Caretaker’s Phone(s) _____________________________________
Approx. how long will donated feed be needed – and how determined ____________________________________________
______________________________________________________________________________________________________
Estimate of feed needs daily; include pellets and other supplemental feeds:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Financial information:
Please describe your situation, including reasons for the unanticipated shortage and timelines for resolution: ______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Please enclose documentation - for example: Checking account statement/ Savings account statement – (please black out the account numbers.) Statement from unemployment office or disability statements or Stubs from SSI or STD payments.
Corroborating reference name and phone number (case worker; banking contact etc.)
______________________________________________________________________________
______________________________________________________________________________
Email to [email protected]
OR
Mail to:
SAFER
9825 Mill Station Rd
Sebastopol CA 95472
707-824-9543
Guidelines for Hay Assistance
No Breeding program of any kind in place for a minimum of 5 years.
Documentation MUST be complete as requested.
Situation must be short term - SAFER will also assist in rehoming horses if that is the best solution.
SAFER has the SOLE RIGHT TO DETERMINE ELEGIBILITY.
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