Anzac Weekend Show QUALIFIER FOR

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1 Anzac Weekend Show QUALIFIER FOR 2018 NSW SOUTHERN CROSS HORSE SPECTACULAR 3 Ring Circus including Newcomer / Show Horse / Show Hunter / Rider Classes / Owner Rider / Lead Line and Interschool Classes/LAAT & LBTT/ Thoroughbred classes ROYAL SHOW QUALIFIER Saturday 22 th April 2017 Park Ridge Pony Club Grounds 117 Judith St, Crestmead Commences at 7.30am Official Measuring Day Starting at 6am Multi-draw raffle tickets available on the day.

2 Entries on the day but please ensure all of your forms/paper work are completed prior Equestrian Queensland Member s $5 each class NON Equestrian Queensland Members may participate on payment of a Restricted Event Membership Fee ($25.00) upon signing of a Restricted Membership Form which includes a Liability Waiver Form (attached) Restricted members please note that there is no personal accident coverage in this restricted membership fee. Classes for restricted members are $10.00 per class All necessary forms are attached please complete forms prior to arrival to save queuing times. THOROUGHBRED CLASSES LATT Open to all Thoroughbreds raced or official barrier trail 4years and over and over 14.2hh who are registered With RISA (Racing Information Services Australia) or ASB (Australian Stud Book). Registrations will be checked on all horses, all horses must be registered Racing name and breeding to be included on entry form Riders must be either Competitor or Participant EA member at the time of entry and competition. Owners must Competitor or Participant EA member at the time of entry and competition. A race or official barrier trial on any registered racetrack in Australia Thoroughbred classes for LIFE BEFORE THE TRACK OR REGISTERED NON RACED THOROUGHBRED Open to all Thoroughbreds 3years and over and over 14.2hh who are registered With RISA (Racing Information Services Australia) or ASB (Australian Stud Book). Registrations will be checked on all horses, all horses must be registered Racing name and breeding to be included on entry form Riders must be either Competitor or Participant EA member at the time of entry and competition. Owners must Competitor or Participant EA member at the time of entry and competition.

3 EA RULES AND CONDITIONS OF ENTRY 1. A horse that wins champion open in a particular class may not enter the same class in another ring. Reserve Champions may compete in another ring. 2. Beginner Youth must be 17 years and under, and not have shown in an open ring. 3. To be eligible to compete in Owner Rider classes, you must be a financial Equestrian Queensland Show Horse Owner Rider member, and the horse must not have been ridden by a professional 3 months prior to this show. Proof of membership and horse registration certificate may be required. Prizes will be 4. All newcomer horses must not have competed under saddle before the 1 st of July 2017 and a Statutory Declaration declaring they have not must be presented if necessary. 5. Horses are not required to be registered with Equestrian Australia (Queensland Branch), for this show ONLY, unless you are requiring points to be accumulated for the Hi-Point Leaderboard or you are participating in the Owner Rider classes. 7. Rings cannot be held up if classes clash. The Committee will do their best to accommodate your class entries. 8. It is the responsibility of all riders/owners/lessee/competitors to be familiar with and aware of all Equestrian Australia rules which govern this sport. For example; the constitution, by-law and policies consist of, but are not limited to: Codes of Conduct, Equine Anti-Doping and Medication Control Regulations. Please refer to the Member Protection Policy, link listed below. ection%20policy.pdf 8A. SHQ can add as many classes as they like to any events which are not EA national qualifiers 9. Equestrian Australia (Queensland Branch) Membership cards MUST be presented to purchase tickets and ride otherwise you will need to pay the Restricted Membership fees and the higher entry fees. 10. All RIDERS must wear an approved helmet with a chin strap fastened at all times. er_2016.pdf 11. For safety reasons, ALL RIDERS must wear suitable riding boots that are heeled and soled, with little or no tread, at all times when riding at EA events. 12. All protests must be submitted in writing to the ringmaster no later than sixty (60) minutes following the completion of the event in question. All protests shall be accompanied by a cash fee of $ which shall be forfeited should the protest be deemed frivolous. 13. Payments - Payments are NON-REFUNDABLE and NON-TRANSFERABLE. 14. Prize/s - Any prize/s not collected on the day of the show will be forfeited. 15. Contact with Appointed Judge/s If it is brought to the attention of the organizing committee that any competitor/rider/owner/lessee has been in contact with and/or makes contact with an appointed judge at any stage throughout the duration of the show, that competitor/rider/owner/lessee will automatically forfeit their right to entry. 16. No Competitor/Spectator shall enter the judges/officials shade tent or you will be automatically forfeit your placing. 17. Leader Board Points-Horse/Rider combination cannot have mixture of points for hunter and open. Once start in Open or Hunter must accumulate points for the high points in the Open or Hunter classes only. 18. Rules pertaining to the restricted membership- Only 1 can be used per calendar year. 19. Interschool classes are for interschool riders only. Must pre-nominate as per the program.

4 20. It is the decision of the EQ Show Horse committee to select the final team for Qld to be sent to the 2018 NSW SOUTHERN CROSS HORSE SPECTACULAR- all winners, champion, res-champion third place getters will be considered. E Q U E S T R I A N NEW SOUTH WA L E S 2018 SOUTHERN CROSS Show Horse Spectacular 16TH, 17TH & 18TH MARCH 2018 SYDNEY INTERNATIONAL EQUESTRIAN CENTRE, HORSLEY PARK To be judged by 3 judges, both International and Australian Champion Newcomer Pony/Galloway/Hack Open and Show Hunters Ridden Open Show Horse and Open Show Hunters Children s Classes Owner/Rider Classes Thoroughbred Handler Fashions in the Field Best Dressed Male and Female Newcomers and Open Thoroughbreds Off the Track Final NSW THE TOP 3 PLACEGETTERS FROM THE FOLLOWING QUALIFYING SHOWS WILL BE INVITED ALONG WITH THE approval of STATE SHOW HORSE COMMITTEE, TO COMPETE AT THIS PRESTIGIOUS EVENT New South Wales Equestrian NSW HOTY 10th/11th/12th March 2017 SIEC Junior Show Horse Championships 5th August 2017 SIEC Equestrian NSW HOTY Newcomer Show 30th September 2017 SIEC Equestrian NSW Show Horse Championships 1st/2nd October 2017 SIEC Canberra Show Horse & Show Jumping Championships 10th/11th/12th November 2017 EPIC Canberra Summer Show Horse Championships 18th/19th/20th January 2018 Willinga Park, Bawley Point Newcomer winners from this show will qualify for the 2019 ENSW Southern Cross Show Horse Championships Western Australia Equestrian WA HOTY 1st/2nd/3rd September 2017 Equestrian WA Autumn Pageant 15th/16th April 2017 Equestrian WA Winter Gala 3rd/4th June 2017 Victoria Equestrian VIC Barastoc HOTY 2017 Equestrian Australia National Show Horse & Rider Championships 1st/2nd/3rd December 2017 Werribee, Vic Queensland Equestrian QLD HOTY 2017 Equestrian QLD Anzac Show Equestrian QLD Horse of the Year Equestrian QLD Newcomers & Childs HOTY Equestrian QLD Spring Show Equestrian QLD Northern Hack Show Rockhampton Tasmania Equestrian TAS HOTY 2017 Northern Territory New Zealand Equestrian NT HOTY 2017 National Horse and Pony Show 12th-15th January 2017 Further qualifying shows to be advised

5 Equestrian Queensland Show Horse Anzac Weekend Show Saturday 22nd April 2017 ~ All Rings commence 8:30am, RING FOUR starts 7.30am ~ Park Ridge Pony Club Grounds RING ONE PONY Judge; Class 101: Smartest on Parade Gelding n.e. 14.0hh mounted Class 102: Smartest on Parade Mare n.e. 14.0hh mounted RING TWO - GALLOWAY Judge; Class 168: Smartest on Parade Gelding over 14.hh n.e. 15hh mounted Class 169: Smartest on Parade Mare over 14hh n.e. 15hh mounted RING THREE - HACKS Judge Class 206: Smartest on Parade Gelding over 15.0hh Class 207: Smartest on Parade Mare over 15.0hh CHAMPION & RESERVE CHAMPION SMARTEST ON PARADE PONY CHAMPION & RESERVE CHAMPION SMARTEST ON PARADE GALLOWAY CHAMPION & RESERVE CHAMPION SMARTEST ON PARADE HACK Class 103: Lead Rein Pony 12.0hh and under Class 103b Lead Rein Shetland pony ne 12hh Class 104: First Ridden pony n.e. 12.hh rider under 12 years Class 104b: First Ridden pony over 12hh n.e. 12.2hh rider under 12 years CHAMPION & RESERVE CHAMPION CHILD S PONY Class 170: Rider 5 years and under Class 171: Rider 6 years and under 8 years Class 172: Rider 8 years and under 12 years Class 173: Rider 12 years and under 14 years CHAMPION & RESERVE CHAMPION JUNIOR RIDER Class 208 : Rider 14 years and under 16 years Class 209: Rider 16 and under 18 years CHAMPION & RESERVE CHAMPION INTERMEDIATE RIDER Class 210: Rider 18 and under 21 years Class 210: Rider 21 years and under 40 years Class 211: Rider 40 years and over CHAMPION & RESERVE CHAMPION SENIOR RIDER Class 105: Newcomer Pony 12.2hh and under Class 106: Newcomer Pony over 12.2hh n.e. 14.0hh CHAMPION & RESERVE CHAMPION NEWCOMER PONY Class 107: Novice Pony 12.2hh and under Class 108: Novice Pony over 12.2hh n.e. 14.0hh CHAMPION & RESERVE CHAMPION NOVICE PONY Class 109: Open Pony 12.0hh and under Class 110: Open Pony Hack for mares n.e. 12.hh Class 111: Open Pony Hack for geldings n.e 12.hh CHAMPION AND RESERVE SMALL PONY HACK Class 112: Open Pony over 12.0hh n.e. 12.2hh Class 112B: Open Pony over 12.2hh n.e. 13.0hh Class 113: Open Pony Hack for mares n.e. 13.hh Class 113B: Open Pony Hack for geldings n.e 13.hh CHAMPION AND RESERVE CHAMPION MEDUIM PONY Class 114: Open Pony over 13.0hh n.e. 13.2hh Class 115: Open Pony over 13.2hh n.e. 14.0hh Class 116: Open Pony Hack for mares over 13hh n.e. 14.0hh Class 117: Open Pony Hack for geldings over 13 n.e. 14.0hh CHAMPION & RESERVE CHAMPION LARGE PONY Class 118: Open Hack over 15.0hh n.e. 15.2hh Class 119: Open Hack over 15.2hh n.e. 16.0hh Class 120: Open Hack over 16.0hh CHAMPION & RESERVE CHAMPION HACK Class 174: Newcomer Galloway over 14.0hh n.e. 14.2hh Class 175: Newcomer Galloway over 14.2hh n.e. 15.0hh CHAMPION & RESERVE CHAMPION NEWCOMER GALLOWAY Class 176: Novice Galloway over 14.0hh n.e. 14.2hh Class 177: Novice Galloway over 14.2hh n.e. 15.0hh CHAMPION & RESERVE CHAMPION NOVICE GALLOWAY Class 178: Open Galloway over 14.0hh n.e. 14.2hh Class 179: Open Galloway over 14.2hh n.e. 15.0hh Class 180: Open Galloway for mares over 14.0hh n.e. 15.0hh Class 181: Open Galloway for geldings over 14.0hh n.e. 15.0hh Class 182: Open Galloway ridden by a child over 14.0hh n.e.15.0hh CHAMPION & RESERVE CHAMPION GALLOWAY Class 183: Open Pony 12.0hh and under Class 184: Open Pony over 12.0hh ne. 12.2hh Class 185: Open Pony over 12.2hh n.e. 13.2hh Class 186: Open Pony over 13.2hh n.e. 14.0hh CHAMPION & RESERVE CHAMPION PONY Class 212: Newcomer Hack over 15.0hh n.e. 16.0hh Class 213: Newcomer Hack over 16.0hh CHAMPION AND RESERVE CHAMPION NEWCOMER HACK Class 214: Novice Hack over 15.0hh n.e. 16.0hh Class 215: Novice Hack over 16.0hh CHAMPION & RESERVE CHAMPION NOVICE HACK Class 216: Open Hack over 15.0hh n.e hh Class 217: Open Hack over 15.2hh n.e. 16.0hh Class 218: Open Hack for mares over 15.0hh n.e. 16.0hh Class 219: Open Hack for geldings over 15.0hh n.e. 16.0hh Class 220: Open Hack ridden by a child over 15.0hh n.e. 16.0hh CHAMPION & RESERVE CHAMPION SMALL HACK Class 221: Open Hack over 16.0hh n.e. 16.2hh Class 222: Open Hack over 16.2hh Class 223: Open Hack for mares over 16.0hh Class 224: Open Hack for geldings over 16.0hh Class 225: Open Hack ridden by a child over 16.0hh CHAMPION & RESERVE CHAMPION LARGE HACK Class 226: Open Galloway over 14.0hh n.e. 14.2hh Class 227: Open Galloway over 14.2hh n.e. 15.0hh CHAMPION & RESERVE CHAMPION GALLOWAY

6 Class 121: Open Galloway over 14.0hh n.e. 14.2hh Class 122: Open Galloway over 14.2hh n.e. 15.0hh CHAMPION & RESERVE CHAMPION GALLOWAY Class 123: Owner Rider Show /Show Hunter Pony ne 12.2hh Class 124: Owner Rider Show /Show Hunter Pony over 12.2hh ne 14.0hh CHAMPION & RESERVE OWNER RIDER SHOW/SHOW HUNTER PONY Class 187: Open Hack over 15.0hh n.e hh Class 188: Open Hack over 15.2hh n.e. 16.0hh Class 189: Open Hack over 16.0hh CHAMPION & RESERVE CHAMPION HACK Class 190: Owner Rider Show/Show Hunter Galloway over 14.0hh n.e. 14.2hh Class 191: Owner Rider Show/ Show Hunter Galloway over 14.2hh n.e. 15.0hh CHAMPION & RESERVE CHAMPION OWNER RIDER SHOW/SHOW HUNTER GALLOWAY Class 228: Open Pony 12.0hh and under Class 229: Open Pony over 12.0hh n.e. 13.0hh Class 230: Open Pony over 13.0hh n.e. 14.0hh CHAMPION & RESERVE CHAMPION PONY Class 231: Owner Rider Hack/Show Hunter Hack over 15.0hh n.e. 16.0hh Class 232: Owner Rider Hack/Show Hunter over 16.0hh CHAMPION & RESERVE CHAMPION OWNER RIDER SHOW/SHOW HUNTER HACK Class 125: Newcomer Show Hunter Pony 12.2hh and under Class 126: Newcomer Show Hunter Pony over 12.2hh n.e. 14.0hh CHAMPION & RESERVE CHAMPION NEWCOMER SHOW HUNTER PONY Class 192: Newcomer Show Hunter Galloway over 14.0hh n.e. 14.2hh Class 193: Newcomer Show Hunter Galloway over 14.2hh n.e. 15.0hh CHAMPION & RESERVE CHAMPION NEWCOMER SHOW HUNTER GALLOWAY Class 233: Newcomer Show Hunter Hack over 15.0hh n.e. 16.0hh Class 234: Newcomer Show Hunter Hack over 16.0hh CHAMPION AND RESERVE CHAMPION NEWCOMER SHOWHUNTER HACK Class 127: Novice Show Hunter Pony 12.2hh and under Class 128: Novice Show Hunter Pony over 12.2hh n.e. 14.0hh CHAMPION & RESERVE CHAMPION NOVICE SHOW HUNTER PONY Class 129: Open Show Hunter Pony 12.0hh and under Class 130: Open Show Hunter Pony for mares n.e. 12.hh Class 131: Open Show Hunter Pony for geldings n.e. 12.hh Class 132: Open Childs Show Hunter Pony n.e. 12.hh CHAMPION & RESERVE CHAMPION SMALL SHOW HUNTER PONY Class 133: Open Show Hunter Pony over 12.0hh n.e. 12.2hh Class 133B Open Show Hunter Pony over 12.2hh n.e. 13.0hh lass 133C : Open Show Hunter Pony for mares over 12.2hh ne 13hh Class 134: Open Show Hunter Pony for geldings over 12hh ne 13hh Class 134B : Open Childs Show Hunter Pony over 12hh ne 13hh CHAMPION & RESERVE CHAMPION MEDUIM SHOW HUNTER PONY Class 194: Novice Show Hunter Galloway over 14.0hh n.e. 14.2hh Class 195: Novice Show Hunter Galloway over 14.2hh n.e. 15.0hh CHAMPION & RESERVE CHAMPION NOVICE SHOW HUNTER GALLOWAY Class 196: Open Show Hunter Galloway over 14.0hh n.e. 14.2hh Class 197: Open Show Hunter Galloway over 14.2hh n.e. 15.0hh Class 198: Open Show Hunter Galloway for mares n.e. 15.0hh Class 199: Open Show Hunter Galloway for geldings n.e. 15.0hh Class 200: Open Childs Show Hunter Galloway n.e. 15.0hh CHAMPION & RESERVE OPEN SHOW HUNTER GALLOWAY Class 235: Novice Show Hunter Hack over 15.0hh n.e. 16.0hh Class 236: Novice Show Hunter Hack over 16.0hh CHAMPION & RESERVE CHAMPION NOVICE SHOW HUNTER HACK Class 237: Open Show Hunter Hack over 15.0hh n.e. 15.2hh Class 238: Open Show Hunter Hack over 15.2hh n.e. 16.0hh Class 239: Open Show Hunter Hack for mares n.e. 16.0hh Class 240: Open Show Hunter Hack for geldings n.e. 16.0hh Class 241: Open Childs Show Hunter Hack n.e. 16.0hh CHAMPION & RESERVE SMALL SHOW HUNTER HACK Class 242: Open Show Hunter Hack over 16.0hh n.e. 16.2hh Class 243: Open Show Hunter Hack over 16.2hh Class 244: Open Show Hunter Hack for mares over. 16.0hh Class 245: Open Show Hunter Hack for geldings over 16.0hh Class 246: Open Childs Show Hunter Hack over 16.0hh CHAMPION & RESERVE LARGE SHOW HUNTER HACK

7 Class 135: Open Show Hunter Pony over 13.0hh ne 13.2HH Class 136: Open Show Hunter Pony over 13.2hh n.e. 14.0hh Class 137: Open Show Hunter Large Pony for mares Class 138: Open Show Hunter Large Pony for geldings Class 139: Open Childs Large Show Hunter Pony CHAMPION & RESERVE CHAMPION LARGE SHOW HUNTER PONY Class 140: Open Show Hunter Galloway over 14.0hh n.e. 14.2hh Class 141: Open Show Hunter Galloway over 14.2hh n.e. 15.0hh CHAMPION & RESERVE CHAMPION SHOW HUNTER GALLOWAY Class 142:Open Show Hunter Hack over 15.0hh n.e. 16.0hh Class 143: Open Show Hunter Hack over 16.0hh CHAMPION & RESERVE CHAMPION SHOW HUNTER HACK Class 201: Open Show Hunter Hack over 15.0hh n.e. 16.0hh Class 202: Open Show Hunter Hack over 16.0hh CHAMPION & RESERVE CHAMPION SHOW HUNTER HACK Class 203: Open Show Hunter Pony 12.0hh and under Class 204: Open Show Hunter Pony over 12.0hh n.e. 13.0hh Class 205: Open Show Hunter Pony over 13.0hh n.e. 14.0hh CHAMPION & RESERVE CHAMPION SHOW HUNTER PONY Class 247: Open Show Hunter Pony 12.0hh and under Class 248: Open Show Hunter Pony over 12.0hh n.e. 13.0hh Class 249: Open Show Hunter Pony over 13.0hh n.e. 14.0hh CHAMPION & RESERVE CHAMPION SHOW HUNTER PONY Class 250: Open Show Hunter Galloway over 14.0hh n.e. 14.2hh Class 251: Open Show Hunter Galloway over 14.2hh n.e. 15.0hh CHAMPION & RESERVE CHAMPION SHOW HUNTER GALLOWAY

8 Ring 4- LATT (Life After the Track) Classes. PROUDLY SPONSORED BY TJ SEARS RACING LIFE AFTER THE TRACK CLASSES & LIFE BEFORE THE TRACK UNRACED THOROUGHBREDS Class 162:Newcomer LATT/LBTT Under 16hh Class 163:Newcomer LATT/LBTT Over 16hh CHAMPION & RESERVE CHAMPION NEWCOMER LATT HORSE Class 164: Open LATT/LBTT 15hh-15.2hh Class 165: Open LATT /LBTT15.2hh -16hh Class 165 B Open LATT/LBTT CHILDS SMALL HACK CHAMPION & RESERVE CHAMPION SMALL LATT HORSE Class 166: Open LATT/LBTT 16hh-16.2hh Class 167: Open LATT /LBTT16.2hh and over Class 167 B Open LATT/LBTT CHILDS LARGE HACK CHAMPION & RESERVE CHAMPION LARGE LATT HORSE Class 168; Newcomer Hunter LATT/LBTT under 16hh Class 169; Newcomer Hunter LATT/LBTT over 16hh CHAMPION & RES CHAMPION NEWCOMER HUNTER HORSE Class 170; HUNTER LATT/LBTT 15hh-15.2hh Class 171 HUNTER LATT/LBTT 15.2hh -16hh Class 171 B Open LATT/LBTT CHILDS SMALL HACK

9 CHAMPION & RESERVE CHAMPION SMALL HUNTER LATT/LBTT HORSE Class 172; HUNTER LATT /LBTT16hh-16.2hh Class 173 HUNTER LATT /LBTT16.2hh and over Class 173 B Open LATT/LBTT CHILDS LARGE HACK CHAMPION & RESERVE CHAMPION LARGE HUNTER LATT/LBTT HORSE **SUPREME HACK OF SHOW** awarded Sash and Rug SPONSORED BY NVS **SUPREME HUNTER OF SHOW** awarded Sash and Rug SPONSORED BY NVS **SUPREME RIDER OF SHOW** awarded Sash and Rug SPONSORED BY NVS **SUPREME CHILDS HACK OF SHOW** awarded Sash & Rug SPONSORED BY NVS

10 SUPREME LATT/LBTT HORSE OF THE SHOW RUG (proudly donated by TJ Sears Racing) EQ SHOW HORSE DATES nd April Anzac Show 4th June Newcomers/Childs Horse of the Year 26th & 27th August Horse of the Year - 17 th June EQ Show Horse Rocky Show 16th & 17th September Spring Show

11 Owner Rider Application Form This form is not a membership application for the Equestrian Australia (Queensland Branch) Inc. To be eligible to apply for Owner Rider status, you must be a financial member of the Equestrian Australia (Queensland Branch) Inc. This Owner Rider application must be accompanied with a copy of your current Equestrian Australia (Queensland Branch) membership card, horse(s) Equestrian Australia (Queensland Branch) registration and height certificate, a Statutory Declaration stating that the applicant meets the requirements to be considered eligible for Owner Rider status in accordance with the Equestrian Queensland Show Horse guidelines regarding Owner Rider requirements and guidelines and a fee of $25. To be eligible to compete in Owner Rider events, you must be registered with Equestrian Queensland Show Horse as an Owner Rider. Payment is non-refundable and non-transferable. If for any reason the processing of your payment is unsuccessful then your application will not be accepted. Owner Rider Rules and Regulations: 1. All riders/owners/leasees, entered or competing in the ridden Equestrian Queensland Show must be financial members of the Equestrian Australia (Queensland Branch) Inc. and all horses entered or competing in the ridden Equestrian Queensland Show must be registered with the Equestrian Australia (Queensland Branch) Inc. Such membership/registrations shall be effective by close of entries. 2. All horses and ponies to have an official EA/EQ lease or be the bona fide property of the rider. An official lease must have been in existence for a period of at least three months prior to the show for the owner-rider classes. 3. Horses and ponies must not have been ridden, trained or exhibited under saddle by any other person in the previous three months. The only exception being those horses and ponies which have been ridden by another person who qualifies as an owner-rider (subject to rule 2) Owner Riders will be required to complete a declaration and acknowledgement to prove eligibility and submit this with their Owner Rider application form. Any protests regarding eligibility must be lodged in writing on the day of the event with $150. Name: EQ Membership No Postal Address: Post Code: Phone: Mobile: If my application for Owner Rider status is accepted, I agree to be bound and abide by the rules, regulations and by-laws of the Equestrian Queensland Show Horse. Signature/Guardian: Please make cheques payable to Show Horse Queensland for $25 Owner Rider Application Checklist: Copy of Current Equestrian Australia (Queensland Branch) Membership Card Copy of Horse(s) current Equestrian Australia (Queensland Branch) Registration Copy of Horse(s) current Equestrian Australia (Queensland Branch) Height Certificate Cheque/Money Order for $25 application fee

12 Biosecurity Horse Health Declaration Event/ Farm: Date: Owner or person in charge of horse/s Full name: Full address: (residential or business) Phone number: Postcode: Fax number: Property of Origin of Horses Full address: (property name, number, street, town) Postcode: QDPI PIC number: Waybill/Movement Document No.: If more than one property of origin please complete multiple forms Horses Reg. Name Description/Sex Brand/Microchip Is your horse HeV vaccinated? Is this vaccination current (date of last vaccination)? 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 3 days leading up to this event. I give my authorisation for the Event Organising Committee/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 abovementioned horses as a result of this veterinary examination. I AGREE TO ENSURE THAT: 1. All horses will be shampooed, rinsed and allowed to dry, and their hooves will be picked clean of all solid material and washed with shampoo. 2. All vehicles and equipment accompanying the horses will be cleaned to remove all solid material that could contain disease agents, and then disinfected. I FURTHER DECLARE THAT: 3. The information contained in this Biosecurity Declaration is true and correct to the best of my knowledge.

13 4. I agree to abide by all conditions that may be imposed at any time by the Event Organising Committee/Manager. 5. I acknowledge that in failure to comply, I may be directed to leave and my nominations will be forfeited. 6. I acknowledge that decontamination and disinfection procedures may be required of me if instructed by the Event Organising Committee/Manager. 7. 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 Manager/Event Organising Committee, it s 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. Signature Name Date Horse Listing Continued Event/Farm: Date: Horses Reg. Name Description/Sex Brand/Microchip Is your horse HeV vaccinated? Is this vaccination current (date of last vaccination)? Signature Date Name

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