2016 NSW Biosecurity Horse HealthDeclaration

EVENTNAME / 2016 Sydney CDI / DATE
COMPETITOR’SNAME
OWNER OR PERSON IN CHARGE OFHORSE/S
HOMEADDRESS
POSTCODE
PHONE(MOBILE) / EMAIL
VEHCILE DESCRIPTION & REGISTRATIONNUMBER
PROPERTY OF ORIGIN OFHORSE/S
FULLADDRESS
(if different fromabove)
POSTCODE
PIC NUMBER (Property IdentificationCode) / ______
DETAILS OF ALL HORSES YOU ARE BRINGING ONTO THEGROUNDS
# / HORSE’S REGISTEREDNAME / DESCRIPTION/SEX / MICROCHIP/BRAND / PIC OFPROPERTYHORSE ISRETURNING TO (IFDIFFERENT FROMABOVE) / CURRENTHENDRA VIRUS VACCINATION
Yes/No
1 / Q
2
3

Declaration by owner or person in charge of horse/sattending:

I, …………………………………………………………………………………...... declare that the horse/s named above has / have been in good health, eating normallyand not shown signs of illness during the last three days leading up to this event. I give my authorisation for the Event OrganisingCommittee/Biosecurity Managertocallforveterinaryinspectionofthehorse/snamedaboveandinmycareshouldtheybeshowingsignsofillnessatanytimeduringthe course of the event. I agree to pay any veterinary fees incurred for the abovementioned horses as a result of this veterinaryexamination.

I AGREE TO ENSURETHAT:

Allhorses,vehiclesandequipmentaccompanyinghorse/swillbecleanandfreeofsolidmaterial(thatcouldcontaindiseaseagents)priorto departing property oforigin.

I FURTHER DECLARETHAT:

1.TheinformationcontainedinthisBiosecurityDeclarationistrueandcorrecttothebestofmyknowledge.

2.IagreetoabidebyallconditionsthatmaybeimposedatanytimebytheEventOrganisingCommittee/BiosecurityManager.

3.I acknowledge that in failure to comply, I may be directed to leave the event and my nominations will beforfeited.

4.IacknowledgethatdecontaminationanddisinfectionproceduresmayberequiredofmeifinstructedbytheEventOrganisingCommittee/Biosecurity Manager.

5.Iacknowledgethatthereisapossibilitythathorsesmightbecomeinfectedwithdiseaseagentsasaresultofanymovementsandifnecessaryhorses and premises will be quarantined in accordance with any legislation covering such occurrences including policies and procedures in effect at thattime.

6.I AGREE TO WAIVE ANY RIGHT TO SEEK COMPENSATION OF ANY TYPE FROM EQUESTRIAN NSW, SYDNEY INTERNATIONAL EQUESTRIAN CENTRE, OR ANY OF THEIR OFFICERS, SERVENTS OR AGENTS FOR ANY LOSS, INJURY OR OTHER DAMAGE ARISING IN ANY WAY WHATSOEVER, DIRECTLY OR INDIRECTLY FROM THE PRESENCE OF THE HENDRA VIRUS IN ANY HORSE OR PERSON ATTENDING THE EVENT OR FROM ANY PERSON OR ANIMAL CONTRACTING ANY ILLNESS OR DISABILITY, FROM THE HENDRA VIRUS, WHETHER DIRECTLY OR INDIRECTLY OR HOWSOEVER OTHERWISE.

…………………………………………………………………………………………………………………….Signature

……………………………………………………………………………………………………………………./ /

Name Date