NEW HORSE/BOARDER INFORMATION
OWNERS
NAME: ____________________ STALL #/
PASTURE:_________________
FULL ADDRESS:________________________________________________________
HOME#:_________________________WORK#:______________________________
PAGER/MOBILE#_________________________EMAIL:
_______________________
HORSE
NAME:__________________SEX: MARE OR
GELDING
AGE:
_______ BREED:_________________
COLOR/MARKINGS/BRANDS/SIZE/ANY
SPECIAL MARKS:_______________________
VETERINARIAN:
________________________ PHONE#: ______________________
BLACKSMITH/FARRIER:
_____________________ PHONE#: ____________________
DOES
YOUR HORSE HAVE BACK SHOES OR SLIDE PLATES:______________________
LAST
DATE WORMED: ________HILLCREST TO WORM: YES_______ NO________
DAILY
WORMER: YES_____ NO _____
PAST
HEALTH PROBLEMS, HORSE HABITS/VICES THAT MIGHT CONCERN
____________________________________________________________________
I,
THE OWNER, in conjunction with the agreement between myself and Hillcrest
Farms, for the boarding of my horse/pony understand that it may, from time to
time be necessary that veterinary examination, treatment or consultation be provided. In the absence of specific written
instruction to the contrary, I hereby authorize the farm to act as my agent on
the arrangement for such services with a licensed veterinarian. Further, I agree to be responsible for the
payment of all fees incurred this payment to be made directly to the
doctor. While I may list a preferred
veterinarian above, should that doctor be unavailable, the farm may call the
doctor of its choice.
____________________________ _______________________
Owner’s
Signature Dated
HALTER
OFF IN THE STALL: YES____ NO ____(If Yes, you must
have a Clip-Halter)
INSURED
NAME:________________________ NUMBER:
_______________________
FEED
AMOUNT: HAY: __________________ GRAIN: ____________(PER
FEEDING)
SPECIAL
FEED:_________________________________________________________
ARRIVAL
DATE: ____________DEPARTURE DATE: ________________ (If you know it)
BOARDER
PROFILE: (Horse Interests, Discipline, things you like-for our farm newsletter,etc.)_________________________________________________________
HOW
DID YOU HEAR ABOUT US?__________________________________________