Mare Information Sheet
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Questroyal North Farm: 58 Dunn Rd.  Stillwater, NY 12170

Email: questroyalnorth@gmail.com   Office: 518-541-3280   Fax: 518-541-3281

NAME OF STALLION: _____________________________SHAREHOLDER #:__________________

NAME OF MARE OWNER:___________________________________________________________ 

Please indicate the Name of Owner in the way you wish it reported to The Jockey Club

MARE NAME: _____________________ YEAR OF BIRTH:_________ MARE’S COLOR:________

Sire:_____________________  Dam:_____________________ Dam’s Sire:________________

Mare’s Current Status: In Foal _____ Barren _____ Maiden _____ Slipped/Aborted_____ Not Bred______

Mare’s 2013 Produce (If Applicable): Foaling Date: ___________ Color: ___________ Sex: __________

IMPORT STATUS: Is This Mare an IMPORT for the 2013 Breeding Season? Yes____ / No____

Import Date:___________________ Country of Origin:__________________________

MARE’S 2013 BOARDING FARM:_________________________ Farm Phone:__________

Farm Fax:____________________________ Farm Email:____________________________

Farm Manager or Contact Person:_______________________________________________

EHV-1: A signed veterinarian certificate with the vaccination date must be on file before mare can be covered.

*EHV-1 must be given no earlier than 90 Days and no later than 7 days before breeding*

SIGNATURE OF OWNER/AGENT:___________________________________ DATE:_____________

Address:____________________________________________________________________________

Main Phone:_______________________ Other Phone:_____________________________

Fax:______________________________ Email:__________________________________

*This form must be on file prior to mare being booked. Thank you for your assistance.*