Equibreed UK Stallion Booking Form 2020 v.1

1.
W: www.equineembryotransfer.co.uk E: enquiry@equineembryotransfer.co.uk P: 01189712994
Barclays Bank Acc no: 83192598 Sort code 20-71-03 VAT Reg no: GB129430885 DEFRA Reg: Embryos UK EE-02 Semen UK 9056- EC
This form must be completed IN FULL before the stallion arrives at the centre, please continue overleaf if required.
OWNER/AGENT DETAILS*
Name: …………………………………………………………………………………... Mobile no: ………………………………………………………….............................
Address: ………………………………………………………………………………………………………………………………………………………….................................
…………………………………………………………………………………………………………………………………………………………………………..............................
Email: ………………………………………………………………………………… Emergency contact: ……………………………………………................................
STALLION DETAILS
Name: …………………………………………………………………………………. Passport number: …………………………………………………...........................
DOB: …………………………………………………………………………………… Microchip number: ……………………………………………….............................
Breeding history: ……………………………………………………………………………………………………………………………………………..................................
Relevant competition history: ……………………………………………………………………………………………………………………………..............................
Services required: SEMEN ASSESSMENT/SEMEN COLLECTION/SEMEN FREEZING/DUMMY TRAINING (pls circle one)
*If you require us to invoice or update a different contact please inform us and provide contact details. Agents acting on behalf of owners must also
provide owner details for invoicing
BREEDING PROGRAM
Stallions Standing at Stud
Nomination contract defined? Y/N Mare owners given Equibreed contracts/price list? Y/N
Semen freezing
How many doses of frozen semen are required?..................................................................................................................................................................
Maximum duration of stay at centre………………………………………………………………………………………………………………….................................
Semen collection/dummy training
Has the stallion ever been collected from before?..............................................................................................................................................................
HEALTH STATUS
Date of CEM tests and results at all three sites: ...........................……………………………………………………………………………………………………
Date of EVA and EIA test and result:………………………………………... Date of Strangles test and result: ............................………………….…….
Referring Vet, Name: ....................................................................…………… Phone number: ..……………….…….……………….…….……………….……...
Vaccination status: ………………………………………………………………….. ’Flu and Tet. Due: …………………………………...........................................
Last wormed:………………………………… Last farrier visit:………………………………….. Has the stallion been ill in the last 6 months? Y/N
Has the stallion been in contact with any infectious disease in the last 3 months? Y/N
Any relevant medical history or behavioral history: …………………………………………………………………………………………………………………..
....................………………………………………………………………………………………………………………………………………………………………………………..
LIVERY
Date of arrival: …………………………………………………………………… Dropped off by: ………………………………………………….................................
Livery required: STABLED / TURNOUT
Feed instructions: ………………………………………………………………… Bedding: ……………………………………………………………..............................
Welfare update instructions: DAILY/ WEEKLY/MONTHLY Veterinary update instructions: ...............................................................
NB. Please do not leave any tack, headcollars or equipment with the stallion when he is dropped at Equibreed UK Ltd.
Declaration; I have read and understood Equibreed UK’s Price List and General Terms and Conditions and associated
risk fact sheets where relevant. I agreed to pay all accounts in full prior to the departure of the stallion
☐I consent to images of my stallion to be used for marketing purposes ☐ I would like my contact details to be included in relevant marketing
communications from Equibreed UK Ltd
Signed: ………………………………………………………………………….. (Owner/Agent) Date: .……………………………………….....
equibreeduk STALLION BOOKING FORM 2020