British Showjumping Horse name* BS Registration number*UELN number:*Microchip number*Rider name* BS Member number*Owner name* BS Member number*Show/venue/activity attending* MM slash DD slash YYYY Date of show/activity* MM slash DD slash YYYY Please confirm your horse currently shows none of the clinical signs listed recent cough of unknown cause recent nasal discharge of unknown cause enlarged lymph notes fever (>38.5oC) recent onset of neurological signs of unknown cause diarrhoea Please confirm the following statements* is not under current investigation for EHV 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 EHV. has been resident in the UK for the last 28 days. 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 >38.5oC. Declaration* 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. Signed* Print name* Role*riderowneradministratorDate* MM slash DD slash YYYY
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