SVF Foundation, Heritage Breeds, Endangered Livestock and Rare Breed Conservation

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Animal Questionnaire

This questionnaire must be completed for every animal. If there are offspring by their side and no pertinent information is available, please note this on the dam's questionnaire.

Name of breeder/owner
Email:
Animal's registered name:
Pet name:
Age:
Sex:
Approximate weight:
Left ear tag number:
Right ear tag number:
Microchip number:
Chip location/type:
Tattoo number and location:
Does this animal have any congenital birth defects?	Yes No
If YES describe defect:
Has this animal ever given birth to offspring with a congenital birth defect?	Yes No
If YES, describe defect:
Has this animal ever given birth to offspring that was unable to be registered?	Yes No
If YES, what trait did it possess to disqualify it from the registry? (Please note we are often interested in animals that do not meet the registry guidelines.):
Vaccines and medicines administered in the last 12 months:
Dewormers used:
Last date dewormers used:
Would you be willing to deworm your livestock prior to delivery to SVF?	Yes No
Current diet (e.g. hay, grain, how much, number of time per day):
Does this animal require any special housing or other needs?	Yes No
If YES, please describe:
Has animal been housed with other animals/species?	Yes No
If YES, was any aggression noted?	Yes No
Is this animal reproductively sound (fertile and able to breed)?:	Yes No
Have any breeding attempts been made?:	Yes No
If YES, have they all been successful?	Yes No
Date of last veterinary exam:
Veterinarian and Phone number (if same on Breeder Questionnaire disregard):
Pedigree information attached?	Yes No
If none, origin of sire and dam:
To the best of your knowledge are there any other breeds in this animal's ancestry?	Yes No
Name of person filling out form: