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Motorsport Australia Licence Form for Driver Dynamics Track Participants

Motorsport Australia Licence Form - Track

First Participant's Name
First Name*
Last Name*
Phone*
Select Gender
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card
Driver's License / ID Card Number*
Issuing State*
Health Statement - Must be completed by all participants

Please tick if you have any significant or recurrent problems with the following:

Anxiety/Depression or other mental health condition
Yes
Diabetes
Yes
Epilepsy
Yes
Fits/Fainting/Dizziness
Yes
Headaches/Migraine/Head Injury
Yes
Heart Disease
Yes

If you have ticked any of the above, you ARE required to provide additional information relating to your condition.

Do you suffer from any allergies?
Yes
Hearing Loss or Deafness
Yes
Do you wear glasses or contact lenses when driving?
Yes

If you have ticked any of the above, you are NOT required to provide information relating to these conditions and can continue with you application.

Is there any other relevant medical information that you wish to advise?

Motorsport Australia may request further information form you or your doctor before accepting your application for a licence. Depending on your medical history or status, Motorsport Australia may not be able to issue you with a licence.

I hereby declare that the above provided information is correct *
Yes
Declaration

I accept the conditions of, and acknowledge the risks arising from, attending or participating in Motorsport Activities being provided by Motorsport Australia and the Entities. I agree to be bound by the rules, regulations and policies of Motorsport Australia at all times as a condition of continuing to hold a licence. The information I have entered into this form is true and correct and I will advise Motorsport Australia immediately if any of the information I have given is no longer true and correct. I have read, understood, acknowledge and agree to the Risk and Warning Disclaimer (Page 2) including the exclusion of statutory guarantees, warning, assumption of risk, release and indemnity.

Your Privacy

Motorsport Australia requires the above information to assess your application for a licence and, if successful, to provide you with Motorsport Australia's services. The information provided by you may be used and disclosed to others by Motorsport Australia for the purposes of Motorsport Australia business. Motorsport Australia may not be able to issue a licence to you if you do not provide all of the information requested above. Full details of Motorsport Australia's privacy policy (including how you can access and correct your personal information and make a complaint) are available at Motorsport Australia's website (www.motorsport.org.au). Motorsport Australia and its partners may send you direct marketing materials from time to time. This is in addition to relevant information which Motorsport Australia may send to you as part of Motorsport Australia's services. 

Please tick this box if you do not want to receive direct marketing from Motorsport Australia or its partners.
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Risk Warning and Disclaimer

RISK WARNING AND ASSUMPTION OF RISK 

Motor Sport Activities are inherently dangerous recreational activities and there is significant risk of injury, disability or death. If you do not wish to be exposed to such risks, then you should not participate in the Motor Sport Activities. 

I acknowledge that: 

• the risks associated with attending or participating in Motor Sport Activities include but are NOT LIMITED to the risk that I may suffer harm as a result of:

• motor vehicles (or parts of them) colliding with other motor vehicles or persons or property; 

• others participants acting dangerously or with lack of skills; 

• high levels of noise exposure; 

• acts of violence and other harmful acts (whether intentional or inadvertent) committed by persons attending or participating in the event; and 

• the failure or unsuitability of facilities (including grand-stands, fences and guard rails) to ensure my safety. 


EXCLUSION OF LIABILITY, RELEASE & INDEMNITY 

In exchange for being able to attend or participate in the Motor Sport Activities, I agree: 

• to release Motorsport Australia and the Entities to the extent that any or all of them are providing Recreational Services from all liability for: 

• my death; 

• any physical or mental injury (including the aggravation, acceleration or recurrence of such an injury); 

• the contraction, aggravation or acceleration of a disease; 

• the coming into existence, the aggravation, acceleration or recurrence of any other condition, circumstance, occurrence, activity, form of behaviour, course of conduct or state of affairs: 

• that is or may be harmful or disadvantageous to me or the community; or 

• that may result in harm or disadvantage to me or the community, howsoever arising from my participation in or attendance at the Motor Sport Activities;

• to indemnify and hold harmless and keep indemnified Motorsport Australia and the Entities to the maximum extent permitted by law in respect of any Claim by any person; and • to attend at or participate in the Motor Sport Activities at my own risk. 

I understand that: 

• nothing in this document excludes, restricts or modifies any rights that I may have as a result of significant personal injury that is caused by the Reckless Conduct of Motorsport Australia and the Entities as the supplier of the Motor Sport Activities / Recreational Services; 

• nothing in this document prevents the Entities from relying on any laws (including statute and common law) that limit or preclude their liability; 

• nothing in this document excludes any term or guarantee which under statute cannot be excluded; however the liability of the Entities is limited to the minimum liability allowable by law; 

• nothing in this document precludes me from making a claim under a Motorsport Australia insurance policy where I am expressly entitled to make a claim under that insurance policy; and 

• Motorsport Australia has arranged some limited personal injury insurance coverage which may provide me with some protection for loss, damage or injury that I may suffer during my participation in the Motor Sport Activities. However, I acknowledge and accept that the insurance taken out by Motorsport Australia may not provide me with full indemnity for loss, damage or injury that I may suffer during my participation in the Motor Sport Activities, and that I may have to pay the excess if a Claim is made under an insurance policy on my behalf. I agree that my own insurance arrangements are ultimately my responsibility and I will arrange any additional coverage at my expense after taking into account Motorsport Australia insurance arrangements, this document and my own circumstances.

Where Motor Sport Activities are held in the following jurisdictions, I acknowledge that I have also read and accept the following warnings: WARNING - FOREGOING RIGHTS UNDER THE COMPETITION AND CONSUMER ACT 2010: Under the Australian Government Consumer Law (which is part of the Competition and Consumer Act 2010 (Commonwealth)), several guarantees are implied into contracts for the supply of certain goods and services. You agree that the application of all or any of the provisions of Subdivision B of Division 1 of Part 3-2 of the Australian Consumer Law (i.e. guarantees relating to the supply of services), the exercise of rights conferred by those provisions, and an liability of Motorsport Australia and the Entities for a failure to comply with any such guarantees, are excluded. However, such exclusion is limited to liability for: 

• Death, physical or mental injury (including aggravation, acceleration or recurrence of such an injury of the individual); 

• Contraction, aggravation or acceleration of a disease of an individual; or 

• The coming into existence, the aggravation, acceleration or recurrence of any other condition, circumstance, occurrence, activity, form of behaviour, course of conduct or state of affairs in relation to an individual that is or may be harmful or disadvantageous to the individual or the community or that may result in harm or disadvantage to the individual or the community. This exclusion does not apply to significant personal injury suffered by the reckless conduct of Motorsport Australia and the Entities. 


WARNING APPLICABLE IN RELATION TO MOTOR SPORT ACTIVITIES HELD IN VICTORIA 

WARNING UNDER THE AUSTRALIAN CONSUMER LAW AND FAIR TRADING ACT 2012:

 Under the Australian Consumer Law (Victoria), several statutory guarantees apply to the supply of certain goods and services. These guarantees mean that the supplier named on this form is required to ensure that the recreational services it supplies to you: 

• are rendered with due care and skill; 

• are reasonably fit for any purpose which you either expressly or by implication, make known to the supplier; and 

• might reasonably be expected to achieve any result you have made known to the supplier. 

Under section 22 of the Australian Consumer Law and Fair Trading Act 2012 (Vic), the supplier is entitled to ask you to agree that these conditions do not apply to you. If you sign this form, you will be agreeing that your rights to sue the supplier under the Australian Consumer Law and Fair Trading Act 2012 if you are killed or injured because the services were not in accordance with these guarantees, are excluded, restricted or modified in the way set out in this form. 

NOTE: The change to your rights, as set out in this form, does not apply if your death or injury is due to gross negligence on the supplier's part. "Gross negligence" in relation to an act or omission, means doing the act or omitting to do an act with reckless disregard, with or without consciousness, for the consequences of the act or omission. See regulation 5 of the Australian Consumer Law and Fair Trading Regulations 2012 and section 22(3)(b) of the Australian Consumer Law and Fair Trading Act 2012. 

WARNING APPLICABLE IN RELATION TO MOTOR SPORT ACTIVITIES HELD IN SOUTH AUSTRALIA 

Your rights: 

Under sections 60 and 61 of the Australian Consumer Law (SA), if a person in trade or commerce supplies you with services including recreational services), there is: 

• a statutory guarantee that those services will be rendered with due care and skill; 

• a statutory guarantee that those services, and any product resulting from those services, will be reasonably fit for the purpose for which the services are being acquired (as long as that purpose is made known to the supplier); and 

• a statutory guarantee that those services, and any product resulting from those services, will be of such a nature, and quality, state or condition, that they might reasonably be expected to achieve the result that the consumer wishes to achieve (as long as that wish is made known to the supplier or a person with whom negotiations have been conducted in relation to the acquisition of the services.

Excluding, Restricting or Modifying Your Rights: 

Under section 42 of the Fair Trading Act 1987 (SA), the supplier of recreational services is entitled to ask you to agree to exclude, restrict or modify his or her liability for any personal injury suffered by you or another person for whom or on whose behalf you are acquiring the services (a third party consumer). If you sign this form, you will be agreeing to exclude, restrict or modify the supplier's liability with the result that compensation may not be payable if you or the third party consumer suffer personal injury.  

Important: 

You do not have to agree to exclude, restrict or modify your rights by signing this form. The supplier may refuse to provide you with the services if you do not agree to exclude, restrict or modify your rights by signing this form. Even if you sign this form, you may still have further legal rights against the supplier. A child under the age of 18 cannot legally agree to exclude, restrict or modify his or her rights. A parent or guardian of a child who acquires recreational services for the child cannot legally agree to exclude, restrict or modify the child's rights.

Agreement to exclude, restrict or modify your rights: 

I agree that the liability of the Motorsport Australia and Entities for any personal injury that may result from the supply of the recreational services that may be suffered by me (or a person for whom or on whose behalf I am acquiring the services is excluded. Further information about your rights can be found at www.ocba.sa.gov.au

DEFINITIONS 

a. "Motorsport Australia" means the Confederation of Australia Motor Sport Ltd. 

b. "Claim" means and includes any action, suit, proceeding, claim, demand or cause of action however arising including but not limited to negligence, BUT does NOT include a claim under a Motorsport Australia insurance policy by any person expressly entitled to make a claim under that insurance policy; 

c. "Entities" means event and competition organisers/promoters/managers, land and track owners/managers/administrators/lessees, Motorsport Australia affiliated clubs, state and territory governments and insured listed in Motorsport Australia' public/product/professional indemnity insurance policies and each of their related bodies corporate (including their related bodies corporate) and each of their organs and agencies, officers/president/directors/executives, employees, servants, agents, partners, providers, members, competitors, drivers, co-drivers, navigators, officials, crew members, pit crew, delegates, licence holders, representatives, commissions, committees, advisers, trustees, councils, panels, shareholders, volunteers, officials, appointees, delegated bodies and sponsors. 

d. "Motor Sport Activities" means any motor sport activities or Recreational Services which are permitted or approved which Motorsport Australia regulates or administers by Motorsport Australia or otherwise under the responsibility / control of Motorsport Australia; 

e. "Reckless Conduct" means conduct where the supplier of the recreational services is aware, or should reasonably have been aware, of a significant risk that the conduct could result in personal injury to another person and engages in the conduct despite the risk and without adequate justification; 

f. "Recreational Services" means (unless otherwise defined in this document) services that consist of participation in: 

a) a sporting activity; or 

b) a similar leisure time pursuit or any other activity that: 

(i) involves a significant degree of physical exertion or physical risk; and 

(ii) is undertaken for the purposes of recreation, enjoyment or leisure.

Current Motorsport Australia Holders
Do you currently hold a Motorsport Australia Licence?*
No
Yes
Current Motorsport Australia licence number
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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