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Mudgeeraba Pony Club Horse and Participant Health Declaration
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* Indicates required question
Riders Name
*
Your answer
Club
Mudgeeraba Pony & Hack Club
Other:
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Arrival Time
*
Time
:
AM
PM
Emergency Contact and phone number
*
Your answer
Have you returned from or been in contact with anyone returning from overseas within the last 14 days
*
Yes
No
Have you any flu-like symptoms?
*
Yes
No
Have you been self-isolating or quarantined in the past 14 days?
*
Yes
No
Do you have a horse here today?
Yes
No
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