Andrea, 08,08,05

Contact Information

Address:

City

Province:

Postal Code

Email Address:

Cell Phone:

Home Phone

Work Phone

Pertinent Physical or Emotional Limitations

Allergies/Medical Info:

AB Health

HORSE INFORMATION:
Please note: At this time, Mission Acres is not accepting stallions and pregnant mares.

Name

Years Owned/Leased

Gender

Breed

Age

Tattoos, brands or other identifying marks

Type of Boarding Interested in: Short Term Paddock (more than 1 horse)

Pasture

Are you the sole owner of your horse?

Yes

No

If no, explain:

Does your horse have any history of colic or other medical problems?

Yes

No

If yes, explain:

Does your horse experience lameness as a result of previous injury?

Yes

No

If yes, explain:

Does your horse have any history of behavioral issues (biting, kicking, pulling back when tied, etc.)?

Yes

No

If yes, explain:

Does your horse crib, chew wood, windsuck, etc.?

Yes

No

If yes, explain:

What else should we know about your horse (e.g., allergies, herd behaviour, history of laminitis)?

What does your horse currently eat (other than hay):

Has your horse ever had or been exposed to Equine Infectious Anemia, Strangles, Equine Herpes, or any other contagious equine disease?

Yes

No

If yes, explain:

Do you clip and/or blanket your horse through the winter?

Yes

No

When was your horse last vaccinated and for what?

When was your horse’s last tetanus shot?

When was your horse dewormed last and with what?

When were your horse’s hooves trimmed last?

Who is your trimmer/farrier?

Please note: Mission Acres expects that all horses will have their hooves trimmed regularly (approximately every 6 weeks). Also, Mission has limited space for shod horses and therefore they must be housed together.

Veterinarian’s Name:

Clinic that Veterinarian works at:

Veterinarian’s Phone:

Resting Heart Rate:

Resting Respirations:

Resting Temperature:

If you cannot be reached and a decision regarding your horse’s health and/or approval of a potential surgery/procedure must be made immediately, what is the maximum cost you will authorize?

Rider’s Name

Mission Acres is a family friendly environment with a diverse group of riders covering an array of experience levels and enjoying a variety of riding disciplines. To maintain a relaxed and fun atmosphere, and continue to provide a safe environment for our horses and riders we ask that all boarders complete the following form.

Today’s Date:

RIDER’S INFORMATION:
*If under 18 a parent or guardian must fill out this form and include their contact info.

Name (first and last)

Age

AEF#

*If applicable Name of Parent/Guardian

*If applicable Name & Contact Info for others that may also supervise Rider:

Goals/Interests

goals

EQUINE BOARDING INFORMATION

Contact Information

Boarder - Over the Age of Majority

Emergency Contact Information