Jimboomba Pony Club Horse Health Declaration
DATE OF VISIT *
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Name of Responsible Person *
Your answer
Phone Number of Responsible Person *
Your answer
Address of Responsible Person *
Your answer
Origin of Horses *
Your answer
PIC Number of Property of Origin *
Your answer
HORSE 1 DETAILS: Name, description, MChip# & Hendra vac Status? *
Your answer
HORSE 2 DETAILS: Name, description, MChip# & Hendra vac Status?
Your answer
HORSE 3 DETAILS: Name, description, MChip# & Hendra vac Status?
Your answer
Address of Destination after visiting the grounds. *
Declaration by owner or person in charge of horse/s attending: I declare that the horse/s named above has / have been in good health, eating normally and not shown signs of illness during the last five days leading up to this event. I give my authorisation for the Event Organising Committee/ Bio-security Manager to call for veterinary inspection of the horse/s named above and in my care should they be showing signs of illness at any time during the course of the event. I agree to pay any veterinary fees incurred for the above mentioned horses as a result of this veterinary examination. I agree that should my horse at any time become sick at the event I will advise the event organisers immediately. *
I AGREE TO ENSURE THAT: 1.All horses, vehicles and equipment accompanying horse/s will be clean and free of solid material (that could contain disease agents) prior to departing property of origin.I FURTHER DECLARE THAT: 2. The information contained in this Bio-security Declaration is true and correct to the best of my knowledge.3 I agree to abide and those people that are assisting me on the day, by all conditions that may be imposed at any time by the Event Organising Committee/Bio-security Manager.4. I acknowledge that in failure to comply, or those people that are assisting me on the day fail to comply, may be directed to leave the event and my nominations will be forfeited.5. I acknowledge that decontamination and disinfection procedures may be required of me if instructed by the Event Organising Committee/Bio-security Manager.6. I acknowledge that there is a possibility that horses might become infected with disease agents as a result of any movements and if necessary horses and premises will be quarantined in accordance with any legislation covering such occurrences including policies and procedures in effect at that time.I agree and acknowledge that the Bio-security Manager/Event Organising Committee, its State or National Affiliated bodies and their members are not in any way liable for any cost, expense, loss, damage, claim, action, proceeding or other liability incurred by or made against me as a result of any movement of horses to the event/farm. *
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