Equine Packet

Equine Packet

For all incoming horses, including new boarders, clinics arrivals, and truck-ins. A separate packet must be completed for each horse. This packet includes Vaccine, Horse Info, and Owner Info (Referenced as Attachment A and Attachment B in the boarding contract). Please be prepared to upload a photo or copy of your Coggins.
ATTACHMENT A
HORSE INFORMATION SHEET
Name of Horse*
Name of Horse Owner*

First NameLast Name
Description of Horse:
Breed*
Height*
Color and Markings*
Age*
Sex*

MareGeldingStallion
Insurance Information
Current Vet and Contact Information*
Current Farrier and Contact Information*
Current Feed Program Information(to be adjusted as needed per ongoing conversation and evaluation)*
Disclosures and Other Information*
A health certificate, a negative Coggins test and proof of required vaccinations is required prior to arrival at the Farm. Please see Vaccine Waiver Form for exceptions.
Signature

Clear
ATTACHMENT B
OWNER INFORMATION SHEET
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information

First NameLast Name
Emergency Contact Relationship
Emergency Contact Phone
Please enter a valid phone number.
Emergency Contact Email
example@example.com
Signature

Clear
Coggins, Health Certificate, and Vaccinations
REQUIRED (unless waived herein): For more information and lists of related Public Health Threats by town, visit N.H. DHHS at http: www.dhhs.nh.gov.
Current Health Certificate. Must be issued by a licensed veterinarian within 30 days. This is waivable ONLY if the horse is being transported from within the state of New Hampshire.

Cancelof
Current Coggins. Must be administered within the past twelve months and must not expire during the Clinic.*

Cancelof
Proof of Required Vaccinations (Unless Waived Herein)

Cancelof
Eastern Equine Encephalitis (EEE). Transmitted by mosquitoes and can be transmitted to Horses and People, is fatal in one-third of severe cases.*

I hereby elect not to vaccination my horse for EEE and I assume all risks and full responsibility and liability for any and all direct or indirect results of not vaccinating the Horse.I have attached proof of vaccination
Rabies. Invasion of the central nervous system by a virus that is fatal if untreated; it also transmits to other animals-- including humans.*

I hereby elect not to vaccination my horse for Rabies and I assume all risks and full responsibility and liability for any and all direct or indirect results of not vaccinating the Horse.I have attached proof of vaccination
West Nile Virus (WNV). A mosquito-born that can be deadly to horses and has been reported in all but a few states.*

I hereby elect not to vaccination my horse for EEE and I assume all risks and full responsibility and liability for any and all direct or indirect results of not vaccinating the Horse.I have attached proof of vaccination
Recommended:
Tetanus Toxoid. When a wound such as a deep puncture is contaminated, toxins from the anaerobic bacterium Clostridium tetani, which thrives in the equine environment, cause lockjaw and general muscle spasms, usually resulting in death.*

I hereby elect not to vaccination my horse for Tetanus Toxoid and I assume all risks and full responsibility and liability for any and all direct or indirect results of not vaccinating the Horse.I have attached proof of vaccination
Influenza. Acute, contagious, viral respiratory-tract inflammation; occurs in isolated cases or in epidemics. Your veterinarian can recommend which form of the vaccine is suitable for your horse.*

I hereby elect not to vaccination my horse for Influenza and I assume all risks and full responsibility and liability for any and all direct or indirect results of not vaccinating the Horse.I have attached proof of vaccination
Strangles. Streptococcus equi- can remain contagious for a month after symptoms subside.*

I hereby elect not to vaccination my horse for Strangles and I assume all risks and full responsibility and liability for any and all direct or indirect results of not vaccinating the Horse.I have attached proof of vaccination
Rhinopneumonitis. Caused by a herpes virus, a contagious infection of the respiratory tract; often induces abortion in pregnant mares.*

I hereby elect not to vaccination my horse for Rhinopneumonitis and I assume all risks and full responsibility and liability for any and all direct or indirect results of not vaccinating the Horse.I have attached proof of vaccination
Name

First NameLast Name
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Equine Packet

Coggins, Health Certificate, and Vaccinations