Colebrook Farms – MARE INFORMATION FORM
PLEASE COMPLETE FULLY (TYPE OR PRINT). THANK YOU
Nancy Wheatley: 1-866-425-7469 Fax: (905) 640-2137
Gayle Bosscher: (416) 881-8924
Fax: (905) 852-4537 John Burness: (416) 984-5200
2011 Breeding Season – Exhibit A
Stallion:
Mare Owner Information (Please list the name as you would like it reported to the Jockey Club)
Name:
Tel:
Address:
Fax:
Cell:
NOTE: If mare is owned by partners and billing is to be divided among them add ownership %
and addresses to back of this form.
Mare Information (If mare has lien or other encumbrance – write details on back of form)
Mare's Name:
Sire:
Dam:
Dam’s Sire:
Date of Birth:
Dkb/br Bay Ch Gray/Roan
Mare Status
 Maiden  In foal  Barren  Slipped  Not Bred in 2010
 Already foaled – 2011 foaling date ___/___/2011 Dkb/br Bay Ch Gray/Roan Filly Colt
2010 stallion bred to
2010 Last Date Bred:
2009 stallion bred to
DOB ___/___/2010 Dkb/br Bay Ch Gray/Roan Filly Colt
2008 stallion bred to
DOB ___/___/2009 Dkb/br Bay Ch Gray/Roan Filly Colt
Is this mare an IMPORT for the 2011 breeding season?
 YES
 NO
If yes, import date:_____________ Country of Origin:__________________
Mare’s Ontario Boarding Farm:
Tel:
Farm Manager:
Cell:
Boarding Farm Address:
Mare’s Veterinarian:
Signature:
(of Owner or Authorized Agent)
Tel:
Date:
THIS FORM MUST BE ON FILE PRIOR TO MARES BEING BOOKED