Damrock Farm            
                                                              
Mare Information Sheet

OWNER: __________________________________________________
Owner’s address: ____________________________________________
City: ____________________________ State: ________ Zip: _________
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:_______________________________________________________
__________________________________________________________________________
Normal diet including supplements and pasture:______________________________________
__________________________________________________________________________
Medications/schedule: ________________________________________________________
__________________________________________________________________________

VACCINATIONS: Date last received  (Those in red are required)
EEE/WEE/VEE ______________     PHF_________________       Rabies _______________
Influenza ____________________    Strangles ______________     Rotavirus ______________
Rhinopneumonitis _____________    Tetanus _______________
    West Nile Virus __________
   
*Combination vaccines may be used    

FOALING HISTORY: Number of previous foals ________  Please note any complications here:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________


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________