Waiver Of Liability/ Consent Form - West Wind Veterinary Hospital printable pdf download

Waiver of Liability/ Consent Form

I, _________________________________________ (Horse Owner or Authorized Agent Name) authorize West

Wind Veterinary Hospital (WWVH) and Equistar Vet Services (EVS) to work on my horse:

__________________________________ (registered horse Name). The procedures to be performed include the

following:

Please initial all that apply:

Foaling

AI Fresh:

Name of Stallion: _____________________________________

AI Frozen:

Name of Stallion:______________________________________

Collect Stallion

Freeze Semen

Embryo Transfer

Open Caslick

Caslick

Other: _____________________________________________________________________________

1. I hereby agree to leave my mare / stallion to be bred and / or cared for by West Wind Veterinary Hospital

(WWVH).

2. All fees are due and payable at time of departure including fees for veterinary services, board, farrier, shipping

costs and any transportation costs. Some additional fees may have to be added after the horse has gone home; such

as, shipping, Canada Customs duty, taxes etc.

3. All stallion contracts are to completed and paid for by the mare owner prior to the mare being bred. A copy of

the completed stallion contract, stallion owner contact information, receipt of payment and a copy of the mare’s

registration papers are necessary before breeding.

4. All horses must be dewormed within 30 days of arrival and vaccinated against WEE/EEE/Tetanus/West

Nile (4 way) and Flu/Rhino (2 way) 2 weeks prior to arrival. Any horse not recently dewormed or vaccinated

will be treated on arrival and billed to the owners account.

5. All animals to be left in the care of WWVH must be in good general health and shall be free of infectious,

contagious or transmittable diseases. Horses will be examined on arrival and unhealthy animals will not be able to

stay.

6. The horse owner acknowledges that the activities taking place at WWVH (such as: breeding, collecting, foaling

and inseminating) are by their inherent nature dangerous activities and that participation by the horse owner,

his/her personnel, and horse(s) exposes them to risk of sickness, injury or death. Horse owner expressly

acknowledges that participation involves a broad range of inherent risk, including but not limited to:

Waiver Of Liability/ Consent Form - West Wind Veterinary Hospital