High Performance Stallion X-Ray Screening Scheme

High Performance Stallion X-Ray Screening Application 2024
To complete this application, you will first need to verify your email address. A verification code will be sent to your email. Please input this code when prompted and proceed.

You will need the below detail to complete your application:
- Equine(s) must be in the correct ownership.
- Equine(s) passport.
- If applying on behalf of someone your email will be the designated contact point.
- If applying on behalf of someone you will require signed declaration from the equine registered owner that you are applying and acting on their behalf for the purposes of this scheme.
Email Validator

High Performance Stallion X-Ray Screening Scheme
Terms and Conditions

Applicant Details
The applicant is:*

The registered owner as documented on their passportActing on behalf of the registered owner of the horse
Please provide the owner's details as in the horse's passport:*

Owner name Owner email

Owner details
Please provide the owner's signed verifcation that the applicant is acting on their behalf.*

Cancelof
Name*

First NameLast Name
Email*
PLEASE NOTE THAT THIS IS THE APPLICATION DESIGNATED EMAIL
County*
Phone Number*

Country CodeArea CodePhone Number
Address*

Address Line 1

Address Line 2

Address Line 3County

Eircode

Stallion Details
Stallion Name*
Stallion UELN*
Year of Birth*
Breed*
If other, please enter breedcode*
Sire Name*
Dam Name*
Sire Studbook of Origin*
i.e. KWPN, ID, AES, WSI, etc
Dam Studbook of Origin*
i.e. KWPN, ID, AES, WSI, etc
Performance/Progeny Performance*
Please give all relevant details and include any performance links

Clinic Options
Preferred Clinic 1*
Preferred Clinic 2*

Feedback
Please indicate how you heard about this scheme?

PhoneEmailHSI Website/Social MediaIrish FieldFarmers JournalAgri LandWord of MouthOther

Declaration
By signing this form, I declare that:
- I understand and agree to the terms and conditions of this scheme in their totality.
- I provide my informed consent to participate in this scheme
- I understand HSI retain ownership of all images taken under this scheme
- I understand and provide consent for my equines’ anonymised data to be used for research purposes, including but not limited to scientific publication
- I understand that HSI will publish a list of awardees (forename, surname, county and equine name) on the HSI website
- I understand that drawdown of funding is subject to the completion of scheme feedback
- I have completed this form correctly and accurately.

Finalisation

Please provide signature below
Signature*
Application Status
Office Use Only
Comments
Office Use Only
Should be Empty: