MARE

Mare Name & Registration No: _______________________________________ Age:__________ Breed:___________________

Maiden Mare?  Yes ____No ____ Foal at Side? Yes____ No ____ # Previous Foals _______________________

List All Current Vaccinations/Dates:_______________________________________________________________________________

Dental Care Up to Date? Yes ___ No____ Body Condition Score:____ Date of Recent Deworming:_____________________

Hoof Care (Shoes?):__________________________ Early Breeding Light Program Details: _____________________________

Stall:  Yes ____ No ____ Outdoor Paddock: Yes____ No____ Pasture: Yes____ No ____

Date of Last Oestrus Cycle: ______________________________ Confirmed by:   Ultrasound           Teasing             Other

Hormone Therapy Details:______________________________________________________________________________________

Veterinary Exam/Pre-Breeding Information: _______________________________________________________________________

Details:______________________________________________________________________________________________________

Foaling History including any difficulties: _________________________________________________________________________

Special Medication:____________________________________________________________________________________________

Feed Routine & Details:________________________________________________________________________________________

Mare Vices/Habits: ____________________________________________________________________________________________

STALLION

Stallion Name & Registration No: _______________________________________ Age: ________ Breed:___________________

Cooled/Frozen Semen: Yes ____ No ____ Hand Breeding/Live Cover: Yes ____ No ____

Veterinary Exam/Pre-Breeding Information: _______________________________________________________________________

Breeding Farm Contact Information:______________________________________________________________________________

______________________________________________________________________________________________________________

Collection/Shipping or Breeding Schedule:________________________________________________________________________

Special Instructions/Contract Specifications:_______________________________________________________________________

______________________________________________________________________________________________________________

OWNER

Owner Emergency Contact Information:____________________________________________________________________________

Address:________________________________________________________________________________________________________

Veterinary Emergency Contact Information:_________________________________________________________________________

AUTHORIZED SIGNATURES

Mare Owner Signature & Date:________________________________________________ Date:______________________________

Veterinary/Breeding Facility Signature: ____________________________________________ Date:___________________________