Horse Surrender Form

Date (DD/MM/YYYY)

Name

Email Address

Phone Number

Street Address 1

Street Address 2

Suburb

State

Postcode

Horse's Name

Gender Gender Mare Filly Colt Gelding Stallion Rig

Horse's Age

Breed

Height

Colour

Brand / Microchip

How long have you owned the horse?

Is this horse rideable?

Does the horse bite/nip?

Does the horse kick?

Does the horse rear?

Does the horse crib?

Does the horse weave?

Does the horse windsuck?

Does the horse float/transport ok?

Please describe any other issues..

What is the horse’s current diet?

Date last wormed?

Is the horse vaccinated? If so when was the last vaccine given?

Date of last hoof trim?

Date of last dental?

Are you aware of the horse having any allergies?

Are you aware of any eye problems?

Are you aware of any respiratory issues?

Are you aware of any lameness issues?

Has the horse foundered previously or suffered with laminitis?

Has the horse had any colic episodes? If so please give as much detail as possible.

Has the horse undergone any surgical procedures? If so please list details.

Please list any other details/information you think may help.

Number