Equine Biosecurity Declaration Form
Please complete this declaration to ensure the health and safety of all horses at our facility or event.
Owner/Handler Full Name
*
First Name
Last Name
Contact Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Horse Name
*
Horse Age (years)
*
Horse Breed
*
Horse Identification (e.g., microchip, passport, or registration number)
Has this horse traveled outside its home property in the past 14 days?
*
Yes
No
Has this horse been in contact with horses from other properties in the past 14 days?
*
Yes
No
Has this horse shown any signs of illness (e.g., fever, nasal discharge, cough, diarrhea, lethargy) in the past 14 days?
*
Yes
No
Please list the most recent vaccinations (type and date) for this horse:
Has this horse attended any equine events or shows in the past 30 days?
*
Yes
No
Signature (please sign below to confirm your declaration)
*
Submit Declaration
Submit Declaration
Should be Empty: