Equine Health Status Declaration for Wilton Pony Club Rallies & Competitions

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To be completed for each horse attending any Pony Club Rally or Competition between 29 March and 12 April 2021. This form should be completed by the rider or owner of the horse and submitted to the venue 24 hours before arrival at the show. Failure to submit a declaration form before will result in the entry being forfeited and the horse will not be allowed on to the venue.

Email *

Horse Name *

Rider Name *

Owner Name *

Venue *

Date of Rally/Competition *

YYYY

Please confirm your horse currently shows none of the clinical signs listed:

Recent cough of unknown cause
Recent nasal discharge of unknown cause
Enlarged lymph nodes.
Fever (>38.5oC)
Recent onset of neurological signs of unknown cause
Diarrhoea

Temperature taken today *

38.5 degrees C or less

Please confirm the following statements:

The above mentioned horse:
Is not under current investigation for EHV infection.
Has not been in contact with and is not kept on the same premises as a horse known to have or be under investigation for EHV.
Has been resident in the UK for the last 28 days.
Is not kept on a yard where horses have been imported from the continent within the previous 28 days.

Please agree to the following statement:

The horse named above will have its temperature taken prior to travel and will not travel should the temperature reading be >38.5oC.

Declaration *

To the best of my knowledge, I confirm and agree to all the statements outlined above. I confirm that I am over 18 years of age.

I confirm and agree with the above statements

I do not agree with the above statements

Name *

Role *

Rider/Owner/Administrator

Date *