Welcome to Cowgirls Gathering Event Waiver & Horse Health by Cowgirls Gathering | Aug 13, 2024 Please enable JavaScript in your browser to complete this form. Name of Provider (1): Ranchero PTY LTD (ACN 650 144 933) The Trustee for Vaquera Unit Trust; (ABN 48 794 706 398) trading as Cowgirls Gathering. Address: PO Box 234 Fernvale QLD 4306. The following pages affect your legal rights and obligations. Please read these carefully and only sign if you fully understand their contents. For Participants under 18 years of age, these documents must be completed by a parent or legal guardian. Description of Activities (2): The Cowgirls Gathering events in 2025 will be held at the Kilkivan Showgrounds, Kilkivan. Details of the event as per the information/program located on our website at www.cowgirlsgathering.com.au. Your Cowgirls Gathering Order Number *Please type in just the numbers from your order for example 1091811. If you have purchased more than one ticket on this order please ensure that everyone on that order completes this form (your tickets will not be released until everyone has completed this waiver, this includes any children).Which event are you attending? *Cowgirls Gathering 📍 Kilkivan Showgrounds 📆 3rd - 5th October 2025Please select the event this waiver & horse health declaration this is for. Name of participant / ticket holder This must match the name of the ticket holder your have purchased.Ticket Holder First & Last Name *FirstLastSelect the + above to add any under 18 years of age that is on your same order. Participant business / organization name:If applicable.Participant age: *Under 1818 - 3030 - 4040 - 5050+For Participants under 18 years of age, these documents must be completed by a parent or legal guardianParticipant street address: *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryParticipant email address: *Participant mobile phone number *Emergency contact name: *FirstLastEmergency contact mobile number: *Emergency contact relationship: Will you be riding and or handling horse/s at the gathering?YesNoPlease note: If you make any changes that affect the date you originally submitted your online waiver, it is your responsibility to complete and resubmit the waiver to ensure it's up to date.CONFIDENTIAL RIDING APPLICATION & MEDICAL HISTORY I am applying to ride at the Cowgirls Gathering event as per the date and location above. I agree to the following:I will only ride the horse in a safe and controlled manner: *YesNoPlease Note: If you answer No to this question we will not be able to take your waiver online, please contact us at Hello@CowgirlGathering.com.au. Submission Notice Submission Not Accepted We are not able to take your submission online as you have answered "NO" to the required question. Please contact us at 0477 727 272 or Hello@CowgirlsGathering.com.au to discuss options. I will wear an Australian Standard Approved helmet: *YesNoI will NOT be wearing an Australian Standard Approved helmet: *YesI will read and follow all signs on the property and follow all instructions: *YesNoPlease Note: If you answer No to this question we will not be able to take your waiver online, please contact us at Hello@CowgirlGathering.com.au. Submission Notice Submission Not Accepted We are not able to take your submission online as you have answered "NO" to the required question. Please contact us at 0477 727 272 or Hello@CowgirlsGathering.com.au to discuss options. I will always wear the correct footwear: *YesNoPlease Note: If you answer No to this question we will not be able to take your waiver online, please contact us at Hello@CowgirlGathering.com.au. Submission Notice Submission Not Accepted We are not able to take your submission online as you have answered "NO" to the required question. Please contact us at 0477 727 272 or Hello@CowgirlsGathering.com.au to discuss options. The Instructor/Guide may cancel my ride without refunding any fee if I do not comply with any of these terms and conditions: *YesNoPlease Note: If you answer No to this question we will not be able to take your waiver online, please contact us at Hello@CowgirlGathering.com.au. Submission Notice Submission Not Accepted We are not able to take your submission online as you have answered "NO" to the required question. Please contact us at 0477 727 272 or Hello@CowgirlsGathering.com.au to discuss options. Riding experience: *Number of times the rider has ridden in the last 12 months.Indicate below the number of times the rider has ridden in total: *00 - 10 > Little experience10 – 20 > Some experience20 - 50 > Average experience50 - 100 > Experienced100 + > Very experiencedAre there any learning difficulties that need to be discussed, so the Instructors/Guides are able to accommodate accordingly?Please describe or leave blank if not applicable. Do you (or your child) suffer from any of the following? Select as many as applicable: *AsthmaHeart ConditionMigrainesDiabetesUneven PupilsDizzinessEpilepsy/FitsMedicationsFaintingBack injuryBlood conditionBlackoutsDisabilityAllergic reactions (even if minor)Recent injuryNot applicableIf not applicable please select "Not applicable".Allergic reactions If applicable, please all details on your allergy, reaction and what treatment is required. If not applicable please leave blank. Other medical and or physical conditions, please describe:If not applicable please leave blank. Allergies, please describe any allergy and reaction:If not applicable please leave blank. Year of last Tetanus Immunisation:If unknown, please leave blank. It is particularly important that people dealing with horses are immunised against tetanus. Tetanus is normally given at five years of age as Triple antigen or CDT and at fifteen years of age as ADT.Is it necessary for you (or your child) to carry their own medication at all times? *YesNoPlease list out details of the drugs/medications:Please include the A) Name of the drug/s B) Frequency C) Dosage if not applicable please leave blank. Consent to medical attention: *YesNoI authorise the instructor in charge to administer first aid and call an ambulance. I agree to bear any cost thereby incurred.RISK WARNING I am aware that by my participation in any activities arranged by the Provider, certain risks or dangers may occur, which could include: Physical, bodily or psychological injury or death. Physical exertion to which I am not accustomed. Failure of equipment or use of inadequate equipment. There may be no or inadequate facilities for treatment or transport to treatment if I am injured. The conditions in which the activities are conducted may vary without warning. I may cause injury to other persons and/or other persons may cause injury to me. I may be injured or die due to the negligence, breach of contract or breach of statutory duty or guarantee of the provider.PRIVACY STATEMENT – PRIVACY ACT 1998 By completing this form you are supplying the Provider with personal information about yourself. This information is needed to ensure your safety during your time with us. The Provider is required to collect this information by our insurance company and by the department of Workplace Health and Safety. This information you provide will not be supplied to any other organisation or used for any other purpose than that which is stated above. (1) Provider includes the officers, employees, agents, contractors, franchisees and assigns of the Provider. (2) Activities includes all activities and services ancillary to or associated with the named Activity, both before and after the Activity, including transportation to and from the location of the Activity whether provided by the Provider or not, briefings, inductions, training, and the provision of information in all manuals, safety guidelines and other documentation provided to or made available to the Participant with respect to the Activity, familiarisation with clothing or equipment and methods of operation of equipment and the wearing and removal of any clothing or equipment associated with the Activity. Unless otherwise specified, a reference to an Activity is a reference to a recreational service or a recreational activity as defined in relevant legislation referred to herein. (3) Recreational services are services that consist of participation in a sporting activity or similar leisure-time pursuit; or any other activity that involves a significant degree of physical exertion or risk and is undertaken for the purposes of recreation, enjoyment or leisure. (4) Personal injury is bodily injury and includes mental and nervous shock and death. Please check to confirm you agree to: *Yes I agree to both 1) The above risk warning, and 2) Cowgirls Gathering Terms & Conditions below For full Terms & Conditions, please visit https://cowgirlsgathering.com.au/termsandconditions/. DECLARATION & SIGNATURE: I have read carefully and understand this risk warning and waiver of liability and sign it freely and voluntarily without inducement of any kind. Participants signature (if over 18): Clear Signature If 18 years and older, sign here. If 18 years and under the legal guardian to sign below.Legal guardian name:FirstLastIf 18 years and underFor participants under the age of 18, signature of legal guardian: Clear Signature By signing you are certifying the below statement.This is to certify that I, as a parent/guardian with legal responsibility for the Participant, acknowledge, understand and accept all of the above and consent to his/her release as provided above. I release and agree to indemnify and hold harmless the Provider (1) from any and all liabilities arising from my minor child’s involvement or participation in the Activities and/or recreational services, even if arising from the negligence of the Provider (1).Date: *Please select today's date. Are you bringing any horses to the gathering? *NoYesIf Yes, you will need to complete the following Horse Health Declaration, if no you can now submit the form. Thank you!Horse Health DeclarationThis is a declaration by owner or persons in charge of the horse/s. If this form is being completed ahead of time (for example a week ahead of the start of the event), it is YOUR responsibility to provide any updates by submitting this form. Name of Event: Cowgirls Gathering Address: The Kilkivan Showgrounds and Equestrian Centre (KSEC) is located at 88 Mudlo Road Kilkivan PIC: QCKK3002 Name of person in charge of the horse/s:FirstLastOnly if different to the above details Property of origin of the horse/s: *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryOnly if different to the above details Horse Information Horse/s Information - please copy/paste and complete the below information (A to H) for each horse: *Include: A) Breed B) Sex C) Colour D) Hendra Vac Yes/No E) Strangles Vac Yes/No F) Microchip Number G) Registered Name H) Comp. Horse Yes/No. If more than one horse please hit the + to add another row. PIC Number: *This is the PIC Number that the horse/s are travelling from to the event.I Agree to ensure that: If required before movement, all horses will be shampooed, rinsed and allowed to dry, and their hooves will picked clean of all solid material and washed with shampoo. Any horses coming from the Cattle Tick Infected Zone must be inspected and treated before entering NSW. Complying with all DPI (Department of Primary Industries) requirements All vehicles and equipment accompanying the horses should be in a clean condition at the start of travel to the above-mentioned event. The information contained in this Horse Health Declaration is true and correct to the bestof my knowledge. I agree to abide by all conditions and directions of the rules and regulations set by Event organisers. I acknowledge that failure to comply with the above may result in refusal of entry to the venue, disqualification or other disciplinary action as decided by event organisers. In the event of horse movement restrictions, each participant will be responsible for the care, maintenance and cost of their horse including feeding and watering. Vehicle Rego Number: *Please provide the vehicle registration number of the car you plan to drive to the event.Please check to confirm you agree to both: *1) The above declaration 2) It's your responsibility to provide an updated form if any of these details change (^) ahead of your entry to the event.(^) Change of details could include, but are not limited to: A) The horse/s you are bringing; B) Declaration of your horse/s health; C) Your bump in and out times to the event; D) Your vehicle details; E) Your Riding Application & Medical History.Your Signature: * Clear Signature To be signed by the owner or persons in charge of the horse/sToday's Date: *Please note if you are making this horse health declaration ahead of the event entry, it your responsibility to re-submit this form if there are any changes to what you have declared above.Submit
