DAMROCK FARM, LLC
                                                   Mare Information Sheet

OWNER: ___________________________________________________________________
Owner’s address: ______________________________________________________________
City: ________________________________ State: ____________ Zip Code: _____________
Home phone: ___________________________ Work: ________________________________
Mobile/other: ___________________________ Pager: _______________________________
E-mail: ______________________________________________________________________

ALTERNATE CONTACT: ______________________________________________________
Home phone: _______________________________ Work: ____________________________
Mobile/other: _______________________________ Pager: ____________________________
E-mail: ______________________________________________________________________

HORSE’S REG. NAME: _________________________________________________________
Barn name:___________________ Age:___________ Breed: ___________________________
Color: ______________ Sex: ___________ Tattoo/brand_______________________________
Registration organization: _________________________ Microchip number_________________
Known allergies: _______________________________________________________________
Known health conditions: _________________________________________________________
____________________________________________________________________________
Current diet including supplements: _________________________________________________
Medications/schedule: __________________________________________________________

VACCINATIONS: Date last received. Those in red are required, others are highly recommended
EEE/WEE/VEE ______________    PHF_________________      Rabies _________________
Influenza ___________________     Strangles _____________      
Rotavirus ________________
Rhinopneumonitis ____________     Tetanus ______________
     West Nile Virus ___________

*Combination vaccines may be used

COVERING STALLION: ____________________________________ LBD ____________

FOALING HISTORY: Number of previous foals ________
Previous complications if known __________________________________________________
___________________________________________________________________________
___________________________________________________________________________

IF OWNER OR AGENT CANNOT BE REACHED, THIS HORSE is _____ is not_____
A CANDIDATE FOR SURGERY IN THE EVENT OF COLIC OR SERIOUS INJURY.
                                                                                                   Owner/agent Initials________