. HORSE QUESTIONNAIRE
(Revised 02/07)
Email may be sent to govhorseguards@yahoo.com
1 Co. Governor's Horse Guards
PO Box 978
Avon, CT 06001
On behalf of the State of Connecticut Military Department and the First Company Governor’s Horse Guards we thank you for considering our State militia as a possible new home for your horse. To assist us in effecting a smooth transition to our stable, we ask that you complete this questionnaire.
Legal Owner’s Name: _______________________________Phone #:______________
Address:________________________________________________________________
Horse’s Registered Name:_____________________Barn Name:___________________
Breed:_______________________Age:__________Height:________Color:__________
Sex:_________ Markings:___________________________________________________
Grain (Brand & Type):___________________________________Hay (Type):_____________
Feed Schedule: Grain (In Pounds) Hay (In Pounds)
AM:__________ AM:____________
PM:__________ PM:____________
Name of Current Veterinarian:______________________________Phone:_________________
Name of Current Farrier:___________________________________Phone:_________________
Name of Current Equine Dentist:_____________________________Phone:________________
Date of Last Deworming:_______________________Wormer Used:______________________
Date of Last Coggins:___________________________ Date of Last Shoeing:_______________
Date of Last Tooth Floating:_______________________________________________________
Has your horse received the following vaccines? If so please provide month and year.
Eastern:_______________Potomac Horse Fever:________________Rabies:________________
Western:______________Strangles:_______________Rhinopneumonitus:__________________
Tetanus:______________ Flu:___________________Other:____________________________
1. Has your horse ever had any lameness problems? If yes, please explain: YES NO
2. Does your horse require any special shoeing? If yes please explain: YES NO
3. Has your horse ever suffered from colic? If yes please explain: YES NO
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Horse Questionnaire
Rev. 02/07
4. Has your horse ever suffered from any other medical problems? If yes, please explain: YES NO
5. Does your horse receive any medications? If yes, Please explain: YES NO
6. Does your horse receive daily turn-out? If yes, how long?
7. Is your horse alone or with other horses? How many?
8. Does your horse have pasture (grass) turn-out? If yes, how often and for how long?
9. What type of stall does your horse have? Please circle one of the following:
Straight Box Run-In Shed
10. Has your horse ever been shown or had any special training? If yes please explain.
11. Will your horse stand comfortably on cross-ties?
12. Will your horse allow his ears, bridle path, muzzle and legs to be trimmed with electric clippers? In no, please explain: YES NO
13. Will your horse allow his sheath to be cleaned?
14. Does your horse have a problem loading onto a trailer, trailering? If yes, please explain YES NO
15. Do you experience any bridling or saddling problems with your horse?
In your opinion, what type of rider can work comfortably with your horse? Circle any that apply
Beginner Intermediate Advanced
16. Please explain why you are seeking a new home for your horse.
17. How did you hear about the State of Connecticut Governor’s Horse Guards?
18. Please include a copy of the breed registration papers, if any, and a current Coggins test report with this form.
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Horse Questionnaire
Rev. 02/07
All horses being considered for acceptance (donations) are subject to (90) day trial period. If it is determined that your horse is not suitable for State militia unit use, it will be returned to the owner (donating party) upon conclusion of the 90 day evaluation period.
Thank you for taking the time to complete this questionnaire. It will significantly assist us in assuring your horse is immediately offered the same careful care you have provided. If you have any questions about our horse management program or about filling out this from, please call our unit at (860) 673-3525, and ask for the Stables Officer or the Captain. You are welcome to visit our stables during unit training. Please call (860)673-3525 to arrange a site visit.
I, as the legal owner of the referenced horse, have read and understand the content herein and grant to the First Company Governor’s Horse Guards permission to evaluate my horse during the (90) day trial period. If at anytime during the trial period it is determined that the my horse is not suitable use, than State of Connecticut First Company Governor’s Horse Guards will return the referenced horse to me.
________________________________________ ________________________________
Signature of Donating Party (Owner) Date
Donating Party (Owner): I authorize the State of Connecticut First Company Governor’s Horse Guards to contact my veterinarian and farrier to discuss the health and soundness of my horse. This information will be helpful to the unit veterinarian in his or her overall evaluation of the horse.
________________________________________ _________________________________
Signature of Donating Party (Owner) Date
________________________________________ _________________________________
Signature of State Militia Unit Officer Date
Official
Use Only
To be completed at the conclusion of the evaluation period and prior to
the acceptance of the horse. Once
acceptance is recommended, a copy of this questionnaire will be furnished to the
State Property Officer for final action.
I, _______________________________________ as the State of Connecticut Military Department Agricultural Worker have reviewed all information contained within the questionnaire and have also assisted with the (90) day trial period and recommend acceptance of the referenced horse.
_______________________________________ _________________________________
Signature of State Agricultural Worker Date
Please return this completed questionnaire to: Or fax to: (860) 673-3525_________
First Company Governor’s Horse Guard