Medication Form

All fields with an asterisk (*) are required to complete the medication form.

Please download and familiarize yourself with Rule 96 - Illegal Practices.

Enter the Show Name.

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Please enter the show date.

Please enter your back/entry number.

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Select your horse's sex.

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Enter your horse's microchip number.

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Enter just digits

Please enter the Agent or Trainer name

Please enter the Exhibitor's name.

Please enter the class(es) you attend to participate in.

Medication Information (To be completed by person administering medication only)

Enter the product name.

Enter the amount administered.

Enter strength of administration.

Select method of administration.

Enter date(s) administered.

Enter time(s) administered.

Enter reason why administered.

Enter Diagnosis

Please sign your name.

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To send a copy to your veterinarian, enter their email address.

Please sign your name.

Enter just digits

The agent/trainer (any adult who has responsibility for the care, custody, control and/or performance of the horse) is responsible for the conditions of the horse and for compliance with all NSBA medication rules. The undersigned further acknowledges that all person involved in the ownership, preparation and/or showing of his horse have read and fully understand and agree to comply with the NSBA medication and humane treatment rules as they appear in the current NSBA Rulebook.

Select your title.

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