Driver / Passenger Indemnity Pheasant Wood Circuit (under 18 years old)

DRIVER & PASSENGER INDEMNITY (under 18 years old) PHEASANT WOOD CIRCUIT

Please Select One *

Driver
Passenger

Name *

First

Last

Address *

Email *

Phone *

Date of Birth *

Motorsport Licence Number *

Motorsport Licence Expiry *

Licence Type *

AASA
Motorsport Australia

Vehicle Make & Model *

Vehicle Rego or Log Book number *

Emergency Contact Name *

Emergency Contact Number *

DISCLAIMER - MOTOR VEHICLES AND ASSOCIATED ACTIVITIES CAN BE DANGEROUS I/ we agree and acknowledge as a condition of entry that One Raceway / Pheasant Wood Pty Ltd, Land Owners, Management, Track Operators, Employees, Promoters, Authorised Officials, Volunteers, Rescue Personnel or any associated Agents or representatives shall not be under any liability for my death or injury or loss or damage to my property which may be incur by me as a result of participating in or being at this event or on this premises, with regards to my rights under the Competition & Consumer Act 2010. I / we acknowledge that the Management, Land Owners, Track Operators, Authorised Officials or Employees have the right to decline or terminate my participation or presence at the facility at any time for whatever reason. I / we agree to the regulations and associated rules that are set by Management, Track Operators, Authorised Officials or Employees for any activities conducted at this facility. I/ we understand that upon my request, I will be allowed to thoroughly inspect the track and facilities and by using the track and facilities I / we acknowledge and agree it to be in a safe condition for activities I choose to undertake. At any time, if I / we observe any element of the track or associated facilities to pose a risk, that I will immediately cease my activity and notify Management of that perceived risk. I / we have read this agreement realising and waiving all liability and assuming all risk and provide comprehensive indemnity for any injury whether causing death or otherwise and / or property damage or loss and fully understand the terms and conditions hereof, and sign this agreement voluntarily and without any inducement, assurance or guarantee whatsoever being made to me and unconditionally release and waive any liability other than any liability which by statute cannot be excluded and subject to other legislation and in particular relevant provisions of the act. By signing this Disclaimer, I / we agree, understand and acknowledge that motor vehicles and associated activities can be dangerous and accidents can and do happen. I / we assume full responsibility for the preparation, roadworthiness and safety of any vehicle used by me (regardless of who owns that vehicle), at this facility and further give an assurance that the vehicle has been thoroughly checked for safety and is in a condition fit to be used on a motor racing circuit and associated areas. I / we have read and understand the terms and conditions contained within this document.

Print Name *

Sign *

PARENT / GUARDIAN CONSENT- PERSONS UNDER 18 YEARS OF AGE *

PRINT NAME

ADDRESS *

Declare I am the Parent / Guardian of the above-named minor who is under 18 years of age. I have read this document and understand its contents, including my acceptance of liability and assumption of risk and have explained the contents to the minor. I consent to the above-named participating in this event at his / her own risk. *

Date *