Shot Clinic Registration Form – West Newbury Riding & Driving Club

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2025 WNRDC Shot Clinic Registration Form

Shot_Clinic_Registration

Name *

First

Last *

Last

BARN Address *

BARN Address

Line 1

Line 2

City

State

Zip Code

Cell Phone *

Email *

Number of Horses *

Horse #1 Name *

Horse #1 Vaccinations/Coggins:

*Rhino/Flu ($42)

*Lyme ($46)

*Coggins Test ($55)

**Core Vaccine ($72)

Other VaccineOther Vaccine

* April 18 **May 2 ----- Core Vaccine = Rabies, EWT, West Nile combo---payment is due at time of service

Horse #1 Services:

Teeth Floating ($150*)

Sheath Cleaning ($62**)

Fecal Check ($36)

Chem CBC Profile ($175)

Botulism Test ($34)

Lyme Test ($136)

*sedation included **sedation not included----payment is due at time of service

Horse #2 Name

Horse #2 Vaccinations/Coggins:

*Rhino/Flu ($42)

*Lyme ($46)

**Core Vaccine ($72)

Other VaccineOther Vaccine

* April 18 **May 2 ----- Core Vaccine = Rabies, EWT, West Nile combo

Horse #2 Services:

Teeth Floating ($150*)

Sheath Cleaning ($62**)

Fecal Check ($36)

Chem CBC Profile ($175)

Botulism Test ($34)

Lyme Test ($136)

*sedation included **sedation not included

Horse #3 Name

Horse #3 Vaccinations/Coggins:

*Rhino/Flu ($42)

*Lyme ($46)

**Core Vaccine ($72)

Other VaccineOther Vaccine

* April 18 **May 2 ----- Core Vaccine = Rabies, EWT, West Nile combo

Horse #3 Services:

Teeth Floating ($150*)

Sheath Cleaning ($62**)

Fecal Check ($36)

Chem CBC Profile ($175)

Botulism Test ($34)

Lyme Test ($136)

*sedation included **sedation not included

Horse #4 Name

Horse #4 Vaccinations/Coggins:

*Rhino/Flu ($42)

*Lyme ($46)

**Core Vaccine ($72)

Other VaccinesOther Vaccines

* April 18 **May 2 ----- Core Vaccine = Rabies, EWT, West Nile combo

Horse #4 Services:

Teeth Floating ($150*)

Sheath Cleaning ($62**)

Fecal Check ($36)

Chem CBC Profile ($175)

Botulism Test ($34)

Lyme Test ($136)

*sedation included **sedation not included

Farm Call Fee (per owner, per visit)

Farm Call Fee ($10)

Additional Information:

If you are human, leave this field blank.

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