ANIMAL APPLICATION FOR ENTRY
This is your entry form, health declaration and movement record.
14 – 16 June 2017
1 Exhibition Road, Wandal QLD 4700
07 4922 4900
[email protected]
PIC QGRH0079
Movement record number:
Please select the relevant animal/s
Horse 
Cattle 
Goat 
Camelid 
Poultry/birds 
Sheep 
Pig 
Owner or exhibitor or person in charge of animal/s
Full Name:
Date of Birth:
Address:
Phone:
Mobile:
Email:
Origin of animal/s - Origin is the property on which the animal/s were prior to movement to the Rockhampton Agricultural Show
PIC:
Address:
Destination of animal/s after show
If ‘No’ please complete below
Returning to origin above? Yes  No 
Full Name:
PIC:
Address:
Phone:
Mobile:
Email
Date movement
commenced
Arrival date at the
grounds
Departure date
from the grounds
PAYMENT OF PRIZE MONEY Prize Money will be paid via Electronic Funds Transfer only.
BANK
BRANCH
ACCOUNT NAME
BSB NO.
ACCOUNT NO.
-
Declaration by owner or person in charge of animal/s
I DELARE THAT:
1. I am the owner or person in charge of the stock listed below.
2. These animal/s are to the best of my knowledge, in good health and have been in good health 7 days prior to entry onto the
Rockhampton Showgrounds Complex.
I AGREE THAT:
1. To pay any costs associated with veterinary consultation for the below listed animals if deemed necessary by the Rockhampton
Agricultural & Citizens Show Society.
2. If required before movement, all animals will be shampooed, rinsed and allowed to dry, and their hooves/feet will be picked clean
of all solid material and washed.
3. All vehicles and equipment will be in a clean condition at the start of travel to the Rockhampton Show Grounds Complex.
4. The information contained in this form is true and correct to the best of my knowledge.
5. I will abide by all conditions and directions of the Agricultural Societies and QCAS rules and regulations.
6. 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 the Rockhampton Agricultural & Citizens Show Society Inc. Management Committee.
7. In the case of an imposed restrictions due to a Biosecurity Event I will be responsible for the care, maintenance and cost of the
animal/s listed below, including feeding and watering.
Owner / person in charge of animals
Signature:
Date
PLEASE LIST ALL ANIMAL/S (including animals that are NOT being exhibited)
Entry closing dates:
Class
No.
Horses: Refer to schedule
Name of animal
Breed
Sex
Underlined fields are the minimum requirement.
Cattle: Friday 12th May
Stud book
number
Date
of
Birth
Poultry/birds: Friday 26th May
Individual
identification
Current
health status
Brand,
microchip, ear
tattoo, NLIS tag
(non-electronic)
Sire’s name
If more lines are required, please print a second copy of this page and fill in this table only.
APPLICATION FOR STABLES, CAMPING, VEHICLE PERMITS, EXHIBITOR PASSES
Stable
Please tick:
Dates
No.
Fee
 Miniature horse
Bedding
$4 per exhibitor, per day, dairy goats ONLY
Camping site
$30 per site for duration of show
Parking permit
Limit of 2 vehicles per camp site
Registration No.
Type of vehicle
Registration No.
Type of vehicle
Dam’s name
Vaccinations
(Hendra, etc),
testing (JD,
CAE, etc)
Entry subtotal
Entry
Fee
Refer to
section
schedule
$
How to Pay Please indicate payment method
Credit Card - MasterCard or Visa
By PHONE: (07) 4922 4900
By INTERNET: www.rockhamptonshow.com.au
Direct Deposit
Account Name: Rockhampton Ag. Show Society Inc.
BSB: 064-709 Account #: 10-733-058
Ref #: Your reference is your Business Name
The following will appear on your bank statement
Rockhampton Agricultural and Cit.
$30 per stable for duration of show
 Stallion/colt  Gelding/mare
Dairy Goats: Friday 9th June
 Heavy horse
BPAY
Biller: 1400261 – Rockhampton Agricultural & Citizens Show Society Inc.
Ref #: Reference is your Full Name
Additional exhibitor passes Passes will be issued on the basis of two (2) passes for the first
four (4) head exhibited, and one (1) pass every two (2) head thereafter. Additional passes $5 each.
Entries (from above)
Administration levy
$1.00
Total
$
By Mail
Return this form and payment. Make your Cheque or Money Order
payable to: Rockhampton Agricultural & Citizens Show Society Inc.
In Person
Present this at the Rockhampton Show Office to Pay by Cash, Cheque or
EFTPOS