Wild horse rehoming request form

Your details

Approved rehomer name:

Contact telephone number:

Approved rehoming address:

Intended use of horses (retain, transfer and/or sell):

Preferred date of pick up:

Preferred time of pickup

Intended transport details (i.e., own transport/transport company name):

Horse sex/approximate age Number requested

Fillies (under 3 years old) - number requested:

Mares (3 years old and over) - number requested:

Colts (under 3 years old) - number requested:

Stallions (3 years old and over) - number requested:

Mares with dependant foals - number requested:

Total number requested:

NSW National Parks and Wildlife Service will, as far as practicable, endeavour to meet any specific, reasonable requests (e.g. sex or age of horses). However, the NSW National Parks and Wildlife Service will not meet requests for certain colours, physical appearance, temperament, source location or size of horses.

Declaration

By signing this form, I declare the following:

Upon loading of the horses on the transportation date:

I accept all responsibility for the horses (and if pregnant, their offspring), including their care, welfare, transport, facilities and all associated costs and liabilitiesI acknowledge NSW National Parks and Wildlife Service is not responsible for the horses or their care, welfare, transport, facilities or costs and liabilitiesI acknowledge NSW National Parks and Wildlife Service is not liable for any future claim, cost, liability or loss arising out of, or in connection with, the horses.

Note: The transportation date is the date on which the horses are loaded onto a transport vehicle and collected by the rehomer (or other person approved by the rehomer) at the NSW National Parks and Wildlife Service temporary holding yards or other location specified by NSW National Parks and Wildlife Service.

I am responsible for the cost of suitable transport from the NSW National Parks and Wildlife Service temporary holding yards, and all ongoing costs and care associated with the rehomed horses to ensure the welfare of the horses.

Yes

Where possible, horses will be selected to meet my specified request. Where this is not possible, horses will be selected for me.

Yes

I will comply with my obligations at law in relation to the horses and their welfare, including but not limited to, under the Prevention of Cruelty to Animals Act 1979, Exhibited Animals Protection Act 1986, the Animal Research Act 1985 and supporting regulations (as applicable to the context).

Yes

I will comply with the Rehoming Guidelines.

Yes

The details that I provided in my approved application to be registered as a rehomer form have not changed.

Yes

Signature of rehomer (individual)

Date of request

Signature of rehomer (Company)

Executed by:

ACN:

In accordance with section 127(1) of the (Cth) acting by:

Name of Secretary/Director

Signature of Secretary/Director

Name of Director

Signature of Director

Date of Request

Privacy Statement

The Department of Climate Change, Energy, the Environment and Water will collect and handle your personal information in accordance with the NSW Privacy and Personal Information Protection Act 1998. The information you provide on this form will be used by the department for the purposes of selecting horses to be provided to you for rehoming. Your personal information may also be disclosed to the NSW Department of Primary Industry, NSW Police and the RSPCA. The provision of this information is voluntary and is required as part of your application to request horses. If you do not provide all the information, the department may not be able to consider your request for horses. You may contact the department to access or update your information. The Department is located at 12 Darcy Street, Parramatta NSW.

Contact Information