Willow Creek Horse Farm
10387 Hogan Road, Swartz Creek, Michigan  48473

810-735-9626      810-735-5979(fax)

ON-LINE HORSE INFORMATION

This form should be used is submitting specific information about your horse, by email:  Only complete this Horse Information if you have previously submitted a membership application.

In order for this application to be processed electronically, EVERY questions must be answer.  If the question does not apply, please place an N/A in the answer box.

Date:

 
Owners Full Name (as it appears on drivers license):

 
Horse's Full & Complete Registered Name:

 
Date of Foaling / Birth:

 
Current Fertility and Breeding Status:

 
Physical Description of the Horse / Include Characteristics Markings:

 
Medical and / or Dietary Needs:
(Please include anything that WCHF should be made aware of)

Veterinary Medicine Clinics / Veterinarians:
(Please list the last two that have rendered care to your horse.  Include name, address, and telephone numbers)

Please list an conditions the horse has been treated for in the last three years., other than routine medical and vaccinations:
(Please include the name, address and telephone number of the treating veterinarian)

Are all required preventative inoculations and treatments, as commonly recognized , current with respect to this horse.
         

Please list the treatment, dates of the treatment(s) and the name, address & telephone number of the person providing the treatment.:

 
Please list the names, complete addresses, telephone number(s), date of birth of any proposed user(s) of any horse:

 
Is there a current and valid Coggins or similar test, which you have results verification and / or an issued certification:
(A copy of this will be require when you bring your horse to WCHF)

 
Will you sign a medical record and / or general record release regarding this horse to allow WCHF to obtain medical records.:

 
IF NOT, please explain in detail:
(Please put N/A in the form box if not applicable to above answer)

 
Please list the last two facilities that you have boarded this horse at and why the arraignment ended:
(Please included name, address and telephone numbers)
(Please put N/A in the form box if not applicable to the above answer)

 
Please describe and disclose any "destructive" habits of this horse, including but not limited to "grooming";  excessive kicking of stall walls and doors;  and / or others; which may require addional arraignments in advance to protect the facility features:
 (Please put N/A in form box if not applicable to above answer)