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To Be Kept By: Mare Meadows Ranch
(Fill out one for each mare to be bred)
Owner's Name _________________________ Phone No. (home)
______________________
(As recorded with the Registry) (work) ________________________ Cell:
_______________
Address:
____________________________________________________________________________
____________________________________________________________________________
Horses Name and Number _____________________________________________________
Foaled_____________ Color _______ Markings
____________________________________
Anticipated arrival date ________________________ Foal at
Side?_____________________
Sire of Foal _________________________________ Date/last
foaling___________________
Does Horse have any dangerous propensities? If yes, describe:
____________________________________________________________________________
Stallion to which mare shall be
bred:______________________________________________
Medical History of Horse: Colic______________________
Frequency___________________
Founder______________________ When__________________________________________
Allergies, if
known_____________________________________________________________
Other________________________________________________________________________
Tetanus Toxoid_________________________________Date___________________________
VEE_________________________________________________________________________
Encephalomyelitis (sleeping sickness), Eastern & Western
Strains______________________
Date of last worming__________________Coggins
Test_______________________________
Feeding Program: Hay type
_________________Amount______________________________
Grain type(s)
_________________Amount__________________________________________
Pellets
______________________Amount__________________________________________
Known allergies to feeds
________________________________________________________
Special Care Requirements
______________________________________________________
Habits________________________________________________________________________
To be contacted in case of emergency, if owner cannot be reached:
______________________________________________________________________________
Name Phone Number
______________________________________________________________________________
Street
State
Zip
Is Horse insured?_________
Insurance Carrier ______________________________Policy
#___________________________
Carrier's Address
________________________________________________________________
Insurance contact for emergencies and phone
number:__________________________________
Veterinary emergency
contact:_____________________________________________________
Name Phone Number
This Horse is/is not considered a surgical candidate in the event of colic
or serious illness
(check one). _____IS _______IS NOT
Owner's Signature _____________________________________
Date_____________________
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