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________