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: ____________________________________________________
VETERINARIAN: __________________________________________
Vet’s address:_______________________________________________
City:____________________________ State: ________ Zip: ________
Vet’s phone:____________________ Phone 2: ____________________
Mobile/other: _____________________ Pager: ____________________
E-mail:_____________________________________________________
HORSE: Registered name/number: ______________________________________________
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)
Rabies _________________________ Flu/rhino _____________ PHF _______________
EEE/WEE/VEE ___________________ Strangles _____________ WNV _______________
Influenza _______________________ Anthrax ______________ Botulism ____________
Rhinopneumonitis _______________ Rotavirus ____________
Tetanus________________________
LAST BREEDING DATE_______________ STALLION ____________________________________
MARE NOTES: Please add any previous known foaling notes or behavior issues here
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IF OWNER OR AGENT CANNOT BE REACHED, THIS MARE and/or FOAL
is _____ is not _____ A CANDIDATE FOR EXTREME LIFE-SAVING MEASURES OR
SURGERY IN THE EVENT OF SERIOUS ILLNESS OR INJURY, INCLUDING THOSE
ARISING FROM FOALING COMPLICATIONS. Owner/agent Initials _______
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