EHV Submission Form

Please complete the following form for each horse attending any show, training or activity run at Keysoe International.

This online form should be completed by the rider or owner of the horse and submitted at least 24 hours before arrival at the show.

Failure to submit a declaration form will result in the entry being forfeited and the horse will not be allowed
on to the venue.

Horse Name

UELN Number

Rider Name

Owner Name

Your Phone Number

BS/BD Registration # (if applicable)

Microchip Number

BS/BD Member # (if applicable)

BS/BD Member # (if applicable)

Your Email Address

Reason for Attending Keysoe:

Date of Event:

Is your horse currently showing any of the following symptoms:
- Recent cough of unknown origin,
- Recent nasal discharge of unknown cause,
- Enlarged lymph notes,
- Fever (>38.5ºc),
- Recent onset of neurological signs of unknown cause
- Diarrhoea
YesNo

Please tick to confirm that the following statements are true concerning your horse:
- This horse is not under current investigation for EHV infection
- This horse has not been in contact with nor is kept on the same premises as a horse known to have or be under investigation for EHV
- This horse has been resident in the UK for the last 28 days
Yes

I agree that the horse named above will have its temperature taken prior to travel and will not travel should the temperature reading be >38.5°C
AgreeDisagree

I, the undersigned, confirm and agree that this form is correct and that I am over 18 years of age.
Signed:

Print name:

Role: