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Activity Name: Arrival date: Departure date:

Owner or person in charge of horse/s: Mobile: Email:

Property address: Town/City: P/Code:

P.I.CProperty Identification Code legally required by the Queensland Department of Primary industriesPLEASE LIST BELOW, ALL HORSES YOU HAVE WITH YOU TODAY.

P.I.C

Number

Hendra Vac Date of lastVaccination

Microchip

Number

Breed

of Horse

Description of HorseExample:- Chestnut, white flash

Registered Name

of Horse

Stable Name

of HorseYes! No!

Declaration by owner or person in charge of horse/s

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 3 days leading up to the

above mentioned reason for entering the grounds. I give my authorisation for the RASQ biosecurity officer to call for a 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 as a result of this.

I agree to ensure that:

1. If required before movement, all horses will be shampooed, rinsed and allowed to dry, and their hooves will be picked clean of all solid materials an d washed with shampoo or antiseptic spray.

2. All vehicles and equipment accompanying the horse/s should be in a clean condition at the start of travel to the Toowoomba Showgrounds.

3. The information contained in this Horse Health Declaration is true and correct to the best of my knowledge.

4. I agree to abide by all conditions, rules and regulations and directions of the RASQ, Equestrian Queensland, Biosecurity Queensland Event organisers.

5. I acknowledge that failure to comply with the above may result in refusal of entry to the venue, disqualification or other disciplinary action as decided by the above mention regulatory bodies/judiciary or disputes committee.

6. In the event of horse/s movement restrictions, each participant will be responsible for the care, maintenance and costs of their horse/s including feeding and washing

Signature Print full name Date

HORSE HEALTH DECLARATIONfor

Clive Berghofer Events Centre

TOOWOOMBA SHOWGROUNDS

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CAMPING & STABLING

Are you Stabling horse/s overnight? (Please tick): Yes! No! Are you Camping overnight? Yes! No!

Please, tick the nights you have booked stables and Camping and complete the Indemnity waiver below if leaving stabled livestock unattended.

Booked Nights Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon

Stabling

CampingINDEMNITY WAIVER

In consideration of livestock being stabled/yarded at the Toowoomba Showgrounds whilst unsupervised.

I, of

Agree not to make any claim against the Royal Agricultural Society of Queensland for any loss or injury sustained at the Toowoomba Showgrounds

Acknowledge that no insurance is provided on my behalf and I am responsible for arranging my own public liability and all other insurance.

Will ensure that all stables/yards are fully secured and regularly cleaned of waste products, food and manure.

Acknowledge that the Royal Agricultural Society of Queensland staff or volunteers are not responsible for my livestock or equipment.

Signature Print full name Date

Other Information or Comments