Horse Health Declaration for QSJC Events

QSEC Horse Health Declaration

Queensland Showjumping Club Events
This horse health declaration is a compulsory document that must be submitted on arrival to QSEC (Queensland State Equestrian CentreIt identifies the owners of the animals being moved, describes the animals being moved and details the health of the animal.
Event Name*
Owner of Horses and/or Dogs*
Organisation/trading name
Address*
Mobile phone*
Format: (000) 000-0000.
Email*
example@example.com
Same as above (disregard section below)
Full Name*
Organisation/trading name
Phone onsite
Format: (000) 000-0000.
Email
example@example.com
Property of Origin Address (Horses and/or Dogs)*
PIC Number*
Date and time of arrival at venue:
Date*

DayMonthYear
Date
Time
Date and time of planned departure:
Date

DayMonthYear
Date
Time
Particulars of designated animal(s)

This section must be completed in full for EVERY horse/dog/approved animal you bring onsite. If you require additional space, complete a second form.*

Rows	Description/Sex	Registered Name	Hendra Vaccinated?
1
2
3
4
5
6
7
8
9
10

NoYes
Date from

MonthDayYear
Date
Date to

MonthDayYear
Date
Declaration I declare that the aforementioned horse/s and other animals has/have been in good health, eating normally and not showing signs of illness during the 3 days leading up to arrival at this venue. I give my authorisation for the designated QSEC or Event Hirer representative to call for a veterinary inspection of the animal/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 also agree to the following:
- In the event that my horse does become sick/injured whilst at QSEC or that I call for a vet for any purpose whilst at QSEC, I will advise QSEC immediately.
- Wash my hands regularly and observe good biosecurity practises whilst at QSEC.
- Shampoo, rinse and dry animals prior to movement, and ensure hooves are clean of all solid matter.
- Ensure all vehicles/equipment accompanying the animal will be in a clean condition at the commencement of travel to QSEC.
- The information supplied in this form is true and correct, to the best of my knowledge.
- I agree to abide by all conditions and directions given by QSEC staff, Event Organiser or any other authorising body.
- 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 QSEC or the Event Organisers.
- I acknowledge that there is a possibility that horses/animals might become infected with disease agents as a result of any movements and if necessary horses/animals may be quarantined in accordance with any legislation covering such occurrences including policies and procedures in effect at that time.
- In the event of horse movement restrictions, each owner/person in charge will be responsible for the care, maintenance and cost of their horses/animals, including feeding and watering.
- I agree and acknowledge that the Venue (QSEC) is in no 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 venue and/or the event.
I will not bring a sick horse to QSEC.

By signing this form, I also acknowledge that QSEC is a glass free facility, including the stables and campgrounds.
Full name*
Signature*

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QSEC Horse Health Declaration