My Story
The Mares
Elite Mare Candidate Brilliant Blume
Louisiana
Elite Mare Roseblume
Elite Mare Dorfblume
The Farm
Pictures
Liability Forms
Liability Release Form
Boarding-Horse Information
Boarding Contract
EJD Liabit
Stock Ties
General Information
Stock Tie Pins
Blume Farm Warmbloods-Home
My Story
The Mares
Elite Mare Candidate Brilliant Blume
Louisiana
Elite Mare Roseblume
Elite Mare Dorfblume
The Farm
Pictures
Liability Forms
Liability Release Form
Boarding-Horse Information
Boarding Contract
EJD Liabit
Stock Ties
General Information
Stock Tie Pins
Boarding-Horse Information
Owner's Name
*
First Name
Last Name
Phone
*
(###)
###
####
Phone 2
(###)
###
####
Email
*
Horse's Name
*
Breed
*
Color
*
Markings
*
DOB
*
Veterinarian Name
*
Veterinarian Phone
*
(###)
###
####
Farrier Name
*
Farrier Phone
*
(###)
###
####
Horse's Previous Medical Issues/ Allergies (type none if none)
*
Insurance
Please list name of company, policy number and phone number
Thank you!
While we do everything possible to contact you in an emergency, please answer the following questions to describe how you would like us to proceed if we are unable to contact you.
Life Threatening Veterinary Care
*
If your horse needs colic surgery, or other costly life saving therapies, do you want to be referred to NCSU Veterinary Teaching Hospital?
Yes, I would like referral to NC State Veterinary Hospital
No, I would not like referral to NC State Veterinary Hospital
Financial Limit
*
I will be solely responsible for all fees and charges incurred and authorize treatment with a cost up to:
$
Treatment Limit
*
I authorize the following care/ treatment for my horse in a life threatening emergency in the event I am not able to be contacted. Please define what you are comfortable having performed, including humane euthanasia
Digital Signature
*
By typing my name below I am signing this document
Date
*
MM
DD
YYYY
Thank you!