GCHEG DErby & Horse Health Declaration Form 2011-1

GCHEG Horse Health Declaration.Owner or Person In Charge of Horse/sFull Name:Full Address:(Residential orBusiness)Phone Number:MobilNumber:Email Address:Property of Origin of Horse/sFull Address :(Property Name,No of Street,Town)Queensland DPI PIC Number:No: OfStockBreed: Description/Sex: Brand/MicrochipNo:OfficialHorseName:StableName:ExampleOnly:Thoroughbred Chestnut Gelding Near ShoulderABC/00004444000Why NotJust RideBobPlease Photocopy this page if travelling with more than 5 Horses.

GCHEG Horse Health Declaration.Declaration by Owner or Person In Charge of Horse/sI, ……………………………………. Declare that the horse/s named above has/havebeen in good health, eating normally and not shown signs of illness during the lastdays leading up to the Gold Coast & Hinterland Equestrian Group, Derby &Unofficial Jumping Day on the 30 sth October 2011.I give my authorisation for the designated Steward to call for veterinary inspection ofthe horse/s named above and in my care should they be showing signs of illness atany time during the course of the event. I agree to pay any veterinary fees incurredas a result of this.I AGREE TO ENSURE THAT:1. If required before movement, all horse/s will be shampooed, rinsed andallowed to dry, and their hooves will be picked clean of all solid material andwashed with shampoo.2. All vehicles and equipment accompanying the horse/s should be in a cleancondition at the start of travel to the Southport Pony Club Grounds, QueenStreet, Southport3. The information contained in this Horse Health Declaration is True andCorrect to the best of my knowledge.4. I Agree to abide by all conditions and directions of the Organising Committee.5. I Acknowledge that failure to comply with the above may result in refusal ofentry to the venue, disqualification or other disciplinary action as decided byGCHEG Disputes Committee.6. In the event of horse movement restriction, each participant will beresponsible for the care, maintenance and cost of their horse/s includingfeeding and watering.__________________ __________________ ________________Signature: Name: Date: