Declaration of Animal Health

This form must be completed and provided to the Manager’s Office at Centennial Parklands Equestrian Centre (CPEC) prior to your horse entering Centennial Parklands (this includes the Centennial Parklands Equestrian Centre and Centennial Park). You must also submit this form whenever your horse returns to CPEC after being offsite for a period of one night or greater.

This form is to be completed by the Booking Client who should be familiar with the disease status of the property the horse has come from immediately prior to entering Centennial Parklands or CPEC. Depending on the area from which the horse is being located we may require an inspection of the horse by a veterinary surgeon.

First Name *

Last Name *

Email Address *

Horse 1 Name *Only one horse per line please

Horse 1 Height (Hands) *

Has Horse 1 stabled at CPEC previously? *

Are you bringing a second horse in at the same time? *

Horse 2 Name *Only complete if returning a second horse

Horse 2 Height (Hands)

Has Horse 2 stabled at CPEC previously? *

Anticipated arrival date? *

Property of origin

Location of horse/s for the past 30 days

Property 1 Name

PIC - Property 1Please enter the PIC of the property if known

Address of Property 1 *

Street address *

City *

State *

Postcode

Please enter property address

Did your horse/s stay at another property during this time? *

YESNO

Property 2 Name

PIC - Property 2Please enter the PIC of the property if known

Property 2 Address *

Street address *

City *

State *

Postcode

Please enter property address.

Vaccination status

Although Hendra Vaccination is not mandatory, Department of Primary Industries recommends that you vaccinate your horse.

Horse 1 - Tetanus and Strangles Vaccination completed on *Please enter month and year

Horse 1 - Vaccinated for Hendra Virus? *

NOYES

Horse 1 - Hendra Vaccination completed onPlease enter month and year

Horse 1 - If you have a Vaccination Certificate please upload here

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Acceptable formats - jpg, jpeg, gif, bmp, png, doc, docx, svg, tif, heif, tiff, pdf, heic, hevc

Horse 1 - If you have a Vaccination Certificate please upload here. *

Browse

Acceptable formats - jpg, jpeg, gif, bmp, png, doc, docx, svg, tif, heif, tiff, pdf, heic, hevc

Horse 2 - Tetanus and Strangles Vaccination completed on *Please enter month and year

Horse 2 - Vaccinated for Hendra Virus? *

NOYES

Horse 2 - Hendra Vaccination completed onPlease enter month and year

Horse 2 - If you have a Vaccination Certificate please upload here

Browse

Acceptable formats - jpg, jpeg, gif, bmp, png, doc, docx, svg, tif, heif, tiff, pdf, heic, hevc

Horse 2 - If you have a Vaccination Certificate please upload here. *

Browse

Acceptable formats - jpg, jpeg, gif, bmp, png, doc, docx, svg, tif, heif, tiff, pdf, heic, hevc

Declaration by the Booking Client

After due inquiry and to the best of my knowledge, during the past 30 days the property of origin of the above listed addresses have not had any horses affected by the following diseases within its boundaries:

Anthrax; Equine infectious anaemia; Equine viral arteritis; Equine morbilllivirus; ringworm.
Any other contagious disease that might not be endemic in the general horse population.
Any “notifiable disease” of horses as per the NSW Department of Primary Industries.
Any contagious disease including diseases of the skin.

I declare that the horse named above has been in good health, eating normally and has not shown any sign of disease in the past three days leading up to transport of the horse into CPEC or Centennial Parklands.

Signs may include but are not limited to discoloured nasal discharge, swelling under the jaw or of the legs, diarrhoea, depression or elevated temperature.

Signature of Booking Client *

Clear

Date signed *

In the interests of the horse population stabled at Centennial Parklands Equestrian Centre, management reserves the right to prevent entry to or remove any horses from Centennial Park and Moore Park Trust lands which do not comply with this Declaration of Health or arrive with an unacceptable health status.

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