Coloured Stallion Coloured Stallion Registration Form

www.theipsa.com
Furbo Hill, Spiddal, Co. Galway, Ireland..
Tel. +353 (0) 91 577 577
Email. [email protected]
Coloured Stallion Registration Form__
(All sections must be completed in Block Capitals only please)
OWNER NAME & ADDRESS
NAME OF ANIMAL (ALL ANIMALS MUST BE NAMED)
st
Name:
1 Choice:
Address:
2 Choice:
nd
rd
3 Choice:
Tel. No.:
Microchip No:
Email:
Equine Premises No:
Year Foaled: __________________
Country of Origin: ____________________
st
(Age of stock taken from Jan 1 in any year)
Is The Horse / Pony Registered With Any Or Another Society?
If Yes:
Society: _____________________________
____________________
Colour: (please√ as appropriate)
Piebald
Skewbald
Other
YES
NO
Reg. No.:
No ____________
_________
__________________
Note / Colour:
•
•
Piebalds are black and white only. Any brown markings particularly on the muzzle or under the belly will
wi mean the
horse is dark brown and it should be registered as a skewbald.
Skewbalds are any other colour and white. e.g. Bay chestnut, Dark Roan and Palomino etc, with white. The white
markings must be on the main body and / or neck and not just in isolation on the mane, tail, legs, and face or
underneath the belly.
(Stallion Registration)
All stallions 3 years old and over must be registered & licensed as such with The Irish Piebald & Skewbald
Association. An annual licensing fee will apply thereafter.
Please contact Claire Flaherty for full details.
Note / Breeding:
•
•
Breeding Details: All Piebalds
ds and Skewbalds can be registered whether or not their breeding is known. If breeding is
known, then Verified Parentage papers will be issued if the I.P.S.A. receives proof
proof of parentage. See the Registration
Checklist Below
If breeding is known further back than Grand Sire please list on separate piece of paper.
IPSA Form 9 – Rev 4 – Oct ’13 – P1
Breeders Details: (please√ as appropriate)
Unknown
Details Below
Name: _________________________ Address: _____________________________
____________________________________________________________________
Sire:
Breed Society
Registration Number
Gr. Sire
Breed Society
Registration Number
Gr. Dam
Breed Society
Registration Number
Dam:
Breed Society
Registration Number
Gr.Sire
Breed Society
Registration Number
Gr. Dam
Breed Society
Registration Number
Check List:
•
•
•
•
•
•
•
The Marking Chart completed (if previously unregistered), stamped & microchip implanted by your Vet.
Completed Veterinary Examination.
DNA taken if required.
This completed application form with all necessary sections completed.
For verified parentage you must enclose with this application form:
Dna SAMPLE and Mares Passport.
The Balance of any fees due:
Recorded return delivery (highly advisable as risk of loss in standard post lies with you) IRL € 10.00
UK €16.00
Fees:
Stallion Registration Fee
Contact Office
I enclose the balance of fees due of €_________
cheques etc**, made payable to The IPSA
**Telephone Credit/Debit Card Payment also accepted – Request call back on receipt of application
I HEREBY CERTIFY THAT THE ABOVE PARTICULARS ARE CORRECT TO THE BEST OF MY KNOWLEDGE AND I AGREE TO ABIDE BY
THE RULES OF THE IRISH PIEBALD & SKEWBALD ASSOCIATION LIMITED.
Signed:
______________________________________________
Send All Documentation To:
Remember!
Please do not risk sending cash in the post.
Date:
_________________________
The Irish Piebald and Skewbald Association,
Furbo Hill, Spiddal, Co. Galway.
IPSA Form 9 – Rev 4 – Oct ’13 – P2
www.theipsa.com
Furbo Hill, Spiddal, Co. Galway, Ireland..
Tel. +353 (0) 91 577 577
Email. [email protected]
VETERINARY EXAMINATION OF STALLIONS
VETERINARY
RY REPORT TO BE COMPLETED IN FULL BY A VETERINARY SURGEON
Name of Stallion ____________________ Year of Birth _______ Microchip No. __________________________Height
__________________________Height________
Heart: Normal
Eyes: Normal
□ Abnormal □ Remarks: _____________________________________________________________________
_____________________________________________________________________
□ Abnormal □ Remarks: ______________________________________________________________________
______________________________________________________________________
Mouth: Normal
□ Abnormal □ Remarks: ____________________________________________________________________
____________________________________________________________________
Examination of Genitalia: Normal
□ Abnormal □ Remarks: _____________________________________________________
____________________________
Limbs including feet: examination for ringbone, sidebone, bone spavin, curbs, etc.
Allowance should be made for obvious injury
Left fore __________________________________________________________________
_______________________________________________________
Right fore _________________________________________________________________
Left hind __________________________________________________________________
Right hind ________________________________________________________________
Movement: evidence of lameness (give reason) ________________________________________________________________
________________________________________________________________
Evidence of shivering, stringhalt or wobbler syndrome: remarks
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Lunging and Endoscopic examinations must be carried out.
out
Lunging (WIND): Normal
□ Abnormal □ Remarks: ________________________________________________
________________________________
Endoscopic Examination: Normal
□ Abnormal □ Remarks: ___________________________________________
_________________________
Upon completion of the above certificate it is also required that you:
•
•
•
Complete the marking chart provided
Implant the microchip provided
Take a hair sample and complete the DNA typing form provided
N.B. Description Should Be Typed Or
Written In Block Capitals
________________________________
Signature & Stamp Of Veterinary
Surgeon / Signature Et Cachet Du
Veterinaire Agree
Vet Ref No.
/
Not To Be The Owner Or Trainer
________________________________
Place & Date (Lieu Et Date)
IPSA
PSA Form 9 – Rev 4 – Oct ’13 – P3
*Indicate Microchip Location with “M”
Neck Lower View
(Encolure Vue Inférieure)
Species:
Equine
Colour (Robe):
Upper Eye Level
(Ligne Supérieure Des Yeux)
Right Side
(Coté Droit)
Muzzle
(Nez)
Left (Gauche)
Right (Droit)
Forelegs Rear View
(Antérieurs Vue Postérieure)
Asinine
Sex (Sexe):
Year (Anne):
/
/
Marking Chart (Signalement Graphique)
Left
LeftSide
Side
(Coté
(CotéGauche)
Gauche)
Height (Hauteur):
Left (Gauche)
Right (Droit)
Hindlegs Rear View
(Postérieurs Vue Postérieure)
New Microchip No. Barcode – Type/ Handwrite if one already present:
(Micro Plaquette)
cms
Microchip Location Description:
Head (Tete)
Neck (Encolure)
Limbs (Jambes)
Left Foreleg
(Ant G)
Right Foreleg
(Ant D)
Description Should Be Typed Or
Written In Block Capitals – See Also
Note Below
______________________________
Signature & Stamp Of Qualified
Veterinary Surgeon Only
(Not To Be The Owner Or Trainer)
Signature Et Cachet Du Veterinaire
Agree
Left Hindleg
(Post G)
Right Hindleg
(Post D)
Body (Corps)
Vet Ref No.: ________/___________
Place & Date (Lieu Et Date)
Acquired Marks
(Marques Acquises)
Note: Veterinary Surgeon Obligations
•
You must ensure that the markings and written description agree (white markings drawn in red).
•
Please also ensure that you sign, date, note place of marking, clearly apply your official stamp and Vet Ref.
•
It is further understood that you are hereby verifying the Colour, Sex, Age, and Height (if applicable) of the
animal and that by applying a new bar code label for the approved microchip you have implanted and location
noted, you have thoroughly checked that no microchip was implanted previously.
IPSA Form 10 - Rev 8 - Sep ’13 - P1