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:_______________________________________________________
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Current diet including supplements and pasture:______________________________________
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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:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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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________