Breeding Admission & Consent Form

Arrival Date

Date

Registered Name

Stable Name

Breed

Sex

Colour

Age

Brands

Mare Owner

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone

Please enter a valid phone number.Format: (00) 0000-0000.

Work Phone

Please enter a valid phone number.Format: 0000-000-000.

Mobile

Please enter a valid phone number.Format: 0000-000-000.

Email

example@example.com

Existing injuries/ Medical Conditions

Last Date Worming

Product Used

( if unknown or over 2 months, horse will be wormed on arrival at Beljay Performance Horses )

Last Vaccination Date for Tetanus / Strangles

( if unknown or over 6 months, horse will be vaccinated on arrival at Beljay Performance Horses )

Is the Mare Vaccinated for HENDRA:

Last Vaccination Date

Microchip No

Insurance

Please tick

Foaling Due Date

Stallion you wish to breed your mare to

Does the mare have a foal at foot?

Foal Colour

DOB

Farrier attendance required

Date of last Trim

Agistment Type

Conditions:
Beljay Performance Horses provides the requested services under and subject to its general trading terms.
I acknowledge and agree:
Visitor risk: Beljay Performance Horses accepts no responsibility for personal injury to me or anyone accompanying me, or for damage to
my property, while I/we are visiting Beljay Performance Horses. I/we enter Beljay Performance Horses’ property at my/our own risk.
Admission and payment: I consent to the described horse being admitted to Beljay Performance Horses for breeding purposes. The horse
will not be released until all costs associated with services, treatments, supplements, veterinary treatment and agistment have been paid in
full.
Emergency authority: Beljay Performance Horses’ staff are authorised to act in the best interests of the horse in an emergency if I am not
contactable.
Lockdown or movement restrictions: Agistment and charges will continue to be charged as normal in the event of a lockdown or movement
restriction affecting the horse.
Account terms: Fortnightly accounts are payable strictly within seven days. Outstanding debts accrue account fees and interest from the
due date.
Responsibility for the horse: Beljay Performance Horses, its officers, employees and agents accept no responsibility for sickness, injury or death
of the admitted horse. For full trading terms, please visit our website www.beljay.com.au

Have you read and understood our General Trading Terms (they can be found on our website www.beljay.com.au/forms)

SIGNATURE OF OWNER/AUTHORISED AGENT

NAME OF OWNER/AUTHORISED AGENT

First NameLast Name

Date

Breeding Admission & Consent Form

Mare History

Services Required

Conditions