ABN: 65 861 621 504 Office Use Only Cattle Entry Form Paid Served by ………….……… To the Secretary, Subject to the Rules, By-Laws, Regulations of the above Society, I wish to make the following entries for the forthcoming Show. Exh No Office Use Only Sect No Class No Name of Animal Carded  Herd Book No Receipt No. ………….……… Data Input by ………….…… DOB Breed Entry Fee Total Entry Fees Payable Please provide your waybill to the Stewards Mr/Mrs/Miss/Ms Exhibitor Details Name …………….……………………………………..………..…………. Are you registered for GST? Yes No  Postal address …………………………………….…..……….….….…… If yes, please provide your ABN. …………………………………………………….……………...…….……. __________________________________ Town………………………... State…….…….. Postcode…..…...…… Phone No…………………….….… Mob …..……………..……………… Email ………..……………...…….…………………………………………  Prizemoney not collected by 30th September will be deemed a donation to the Show Society. Please take full payment from credit card: __ __ __ __-__ __ __ __-__ __ __ __-__ __ __ __ Expiry __ __ / __ __ I hereby certify that my Entries are my bona fide property and that I have read the Show Rules and the Conditions of Entry and agree to be bound thereby. I have provided a copy of certification that all livestock entered on this form are guaranteed free of ticks & any notifiable or dangerous diseases. Owner’s Signature……………………………..………………… Date……………………………………...……… Please turn over & provide Insurance information or sign the Dangerous Activity Acknowledgement Telephone (07) 4091 4260 Email: [email protected] Web: www.athertonshow.com.au It will be necessary for any persons competing or exhibiting at the Atherton Show to show proof of their Public Liability Insurance or to sign the Dangerous Activity Acknowledgement. A valid Certificate of Currency must be provided showing that you hold a policy which covers you for a minimum of $10 Million and that you are covered anywhere in Australia. Please speak to your insurance provider to ensure this is included.   I have attached my Certificate of Currency. Please do not tick this box unless the Certificate is attached. I will sign the Dangerous Activity Acknowledgement below. Dangerous Activity Acknowledgement Participant Details Mr/Mrs/Miss/Ms Full Name ……….…………………………………….………..………………………………….. If under 18 years Guardian's Full Name ...…………………………….....………..……………………………….. In consideration for being permitted to participate in any way in cattle handling activities, I, the undersigned, understand, acknowledge and accept: • • • That cattle handling is a dangerous activity and cattle can act in a sudden and unpredictable (changeable) way, especially if frightened or hurt. That there is a significant risk that serious injury or death may result from cattle handling activities. The dangers associated with the consumption of alcohol or any mind altering drugs and agree not to drink alcohol or take drugs prohibited by law before or during any cattle handling activities. I agree to follow the directions of any event organiser or official and that any misconduct or refusal by me to follow any direction of any organiser or official can result in the cancellation of my participation in the activities and my immediate removal from the Arena or the Showgrounds no matter where that may occur. I agree to take all appropriate safety measures at all times whilst participating in the activities. I agree to indemnify the Atherton Tableland Agricultural Society Inc, against Liability for any accident, damage, loss or illness caused to anyone, including but not limited to myself or my property, or a member of the public during any part of the event, including but not limited to preparation, competition, judging, performing or displaying. I have had sufficient opportunity to read this Dangerous Activity Acknowledgement and fully understand its terms and sign it freely and voluntarily. Signature of participant …………………..……………………………………… Date………………………………...…… For Participants of Minority Age (Under Age 18) This is to certify that I, as a parent/guardian with legal responsibility for this participant, acknowledge, understand and accept all of the above and consent and agree to my minor child's involvement or participation in cattle handling activities. Signature of guardian ………………..…………………………………… Date……………………………………...…… Telephone (07) 4091 4260 Email: [email protected] Web: www.athertonshow.com.au