HORSE BOARDING INFORMATION FORM

OWNER/HORSE INFORMATION

OWNER:

Owner's Name ____________________________________

Address: _________________________________________

City/State/Zip: _____________________________________

Home Phone: ____________   Work Phone: _____________

HORSE:

Anticipated Arrival Date: ____________      Anticipated Departure Date: ____________

Horse's Name: _________________________________________________________

Age: __________  Sex: ___________  Color: ______________

Markings __________________________________________________________________________________

Does Horse have any dangerous habits? ______   If yes, describe:__________________________________

__________________________________________________________________________________________

Preferred Farrier and Schedule: _____________________________  Phone: __________________

Preferred Veterinarian: ____________________________________  Phone: ___________________

MEDICAL HISTORY OF HORSE:

Colic:___________ Frequency: ______________________________________

Founder:_________ When: ________________________________________

Other: ________________Description: ____              _____________________________________________

Allergies, if known: ________________________________________________________________________

Date of last worming: _______________________   Type used: ______________________________

VACCINATION HISTORY:

FEEDING PROGRAM:

Hay type: ____________________    Amount:________________    Frequency: __________

Grain type(s): _________________    Amount: ________________    Frequency: __________

Pellets: ______________________    Amount: ________________    Frequency: __________

Supplements: _________________    Amount: ________________      Frequency: __________

Known allergies to feeds: _______________________________________________________

Special Care Requirements: _____________________________________________________________________

Emergency Contact Information (if owner cannot be reached)

Name: ____________________________________________ Phone: ________________________

Street/State/Zip: ___________________________________________________________________

Is Horse insured?:_________ Insurance Carrier: _________________________________   ________

Policy #:____________________Carrier's Address: _______________________________________

Insurance contact for emergencies and phone number:_______________________

Veterinary emergency contact:

Name: ___________________________________________  Phone: __________________________

This Horse ____IS or ____IS NOT considered a surgical candidate in the event of serious illness or injury.

Owner's Initials_______

Owner's Signature: ______________________________________________  Date: __________________

STABLE:

Stable Name: ________________________________________________

Address: ___________________________________________________

City/ State/ Zip: ______________________________________________

Phone (Day): ________________   Phone (Evening): _________________

Stable's Authorized Signature: ______________________________________________