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.

Work Phone

Please enter a valid phone number.

Mobile

Please enter a valid phone number.

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:

YesNo

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?

FillyColt

Foal Colour

DOB

Farrier attendance required

YesNo

Date of last Trim

Agistment Type

$22 plus gst per day$25 plus gst per day mare and foal$30 plus gst per day private agistment (individual stable)$40 plus gst per day stallion agistment

Beljay Performance Horses supplies the requested services under and subject to its general trading terms. I acknowledge and agree:

• Beljay Performance Horses takes no responsibility for personal injury to me or anyone accompanying me or damage to my property while I/we are visiting Beljay Performance Horses. I/we enter Beljay Performance Horses’ property at my/our own risk.
• I consent to the horse described, being admitted to Beljay Performance Horses for breeding purposes. I agree that the above mentioned horse will not be released until all costs associated with services, treatments, supplements, veterinary treatment and agistment are paid in full.
• Beljay Performance Horses’ staff are authorised to act in the best interest of the horse in an emergency if I am not contactable.
Agistment will be charged as normal in the event of a lock down or movement restriction affecting the horse.
• Fortnightly account terms are strictly 7 days, outstanding debts accrue account fees and interest from the due date.
• Beljay Performance Horses, its officers, employees and agents take no reasonability for sickness, accidents injury or death of admitted horse (stallion/mare/unborn foal/foal). The owner understands and acknowledges that entering Beljay Performance Horses land/property it entails safety risk, and we will not be responsible for accident or injury to the horse, any foal or human

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

Yes

SIGNATURE OF OWNER/AUTHORISED AGENT

NAME OF OWNER/AUTHORISED AGENT

First NameLast Name

Date

Breeding Admission & Consent Form

Mare History

Services Required

Conditions