Placement Program Horse Questionnaire

Fill out the Horse Questionnaire below in its entirety and in as much detail as possible. Completion of this form does not mean the retired racing Thoroughbred in question has been accepted into the CARMA Placement Program. This document is to used gather required information for the equine to be considered.

To be eligible, the connections must participate in the 3/10 of 1% Purse Contribution Program. The horse must be a filly, mare or gelding who has raced at Santa Anita Park, Del Mar Thoroughbred Club, Los Alamitos Thoroughbred Racing, Golden Gate Fields or California Authority of Racing Fairs in the last six months. Unraced Thoroughbreds currently in training may be eligible as capacity permits.

Horse Info

Connections

Vet/Care Info

Sign & Submit

Contact Info

Please enter your contact information below. We'll reach out to you after receiving your submission to confirm all information is correct and to provide next steps on moving forward with our Placement Program.

First Name*

Last Name*

Phone Number*

ex. 555-555-5555

Email*

General Horse Info

Horse's Name*

Foaling Year*

Sex*

Tattoo/Microchip Number*

Coat Color*

Height*

Horse's height in hands.

Weight*

Horse's weight in lbs (3 or 4 digit number).

Markings*

Stable Info

Current Stabling Location*

Barn Name/Number*

Stall Number*

Racing Info

Career Starts*

Last Race Date*

Last Raced Track*

Last Workout Date*

Last Workout Track*

Retirement Date*

Behavioral Info

Has this horse shown aggressive or dangerous behavior while in your care (i.e. biting, striking, rearing, kicking)? Please note: this will not disqualify the horse.*

Yes

Please describe the horse's temperament, characteristics and quirks.*

Does this horse have any vices (i.e. stall walking, weaving and/or cribbing)?*

Yes

Describe any vices this horse has.*

Trainer Info

Trainer Name*

Trainer Phone*

ex. 555-555-5555

Trainer Email*

Owner Info

Owner Name*

Owner Phone*

ex. 555-555-5555

Owner Email*

Street Address*

City*

State*

Use two-letter abbreviation (ie CA, KY, NY, etc.)

Zip*

Use 5-digit zip

A MINIMUM $500 DONATION IS REQUIRED FOR ALL RACED HORSES ADMITTED INTO THE CARMA PLACEMENT PROGRAM. UNRACED HORSES IN TRAINING ARE $1,000.

Donations can be made by check, cash or you can make your donation online now. If the horse is accepted into the Placement Program, by signing (typing my name and date) below, I agree to donate a minimum of $500 before the horse will be admitted to the Program.

Donation Acknowledgement*

I agree to donate a minimum of $500 before the horse will be admitted to the Program.

Owner or Authorized Agent Signature*

Today's Date*

By signing below, I give permission for CARMA representative to access pertinent health records and diagnostic reports to facilitate in the assessment and consideration of this horse in the CARMA Placement Program. I also understand any verifiable misinformation on this document may be grounds for judiciary action by the racing stewards.

Health Records Permission*

I give permission for CARMA representative to access pertinent health records and diagnostic reports.

Owner or Authorized Agent Signature*

Today's Date*

Upon completion of this document, a CARMA representative will contact you to discuss admittance and next steps.

This field should be left blank

Contact Info

General Horse Info

Stable Info

Racing Info

Behavioral Info

Trainer Info

Owner Info

Veterinarian Info

Horse Health Info

CARMA