HEALTH DECLARATION | Yorkshire EC

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EQUINE REHABILITATION & HYDROTHERAPY TERMS & CONDITIONS

CONSENT FORM | REFERRALS | DISCLAIMER

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TERMS & CONDITIONS

LIVERY CONTRACT

EQUINE HYDROTHERAPY LIVERY HEALTH DECLARATION FORM

For Biosecurity purposes, please complete this form and send to Yorkshire EC 24 hrs prior to your horse's overnight or treadmill livery stay.

Livery Health Declaration Form Printable Version

Online Livery Health Declaration Form

Horse's Name

Owner's Name

Passport or Microchip No

Insurance Policy Number

Please confirm that your horse is covered by a Public Liabilty/Third Party Policy *

Yes my horse is covered for Public Liabilty / Third Party Cover

Date arriving at YEC

Date due to leave YEC

I confirm each of the following statements: * Required

The abovementioned horse is not under current investigation for Equine Flu, Strangles, EHV or unknown infection.

has not been in contact with and is not kept on the same premises as a horse known to have or be under investigation for infection.

has been resident in the UK for the last 28 days

I confirm that my horse is currently showing NONE of the following clinical signs: * Required

recent cough of unknown cause

recent nasal discharge of unknown cause

enlarged lymph nodes

fever (more than 38.3oC)

recent onset of neurological signs of unknown cause

diarrhoea

Please agree to the following statement: "Should the horse take ill on site, I understand Yorkshire EC can not cater as a treatment facility and stabling is not available for such, and my horse will need to return home/vets for treatment." *

Yes I agree

Please agree to the following statement: "The horse named above will have its temperature taken prior to travel and will not travel should the temperature reading be more than 38.3C." *

Yes I agree

Please confirm the following statements:The horse has completed the primary course (1st and 2nd vaccine) for Equine Flu and the last booster was: *

Yes the horse has completed the primary course and is up to date with any subsequent booster

Please select the date of the most recent booster

Anything that we should know?

To the best of my knowledge, I confirm and agree to all the statements outlined above. I confirm that I am over 18 years of age.

Your Signature

Select today's date

Thanks for submitting the Health Declaration, we look forward to welcoming you and your horse at Yorkshire EC

Yorkshire EC

Laith Staid Lane,
Huddleston,
South Milford,
Leeds,
N Yorkshire
LS25 6JX

General enquiries
office@yorkshireec.co.uk

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