ENTRY FORM

Wombat Rallysprint

12th September 2009
Office Use Only

Competitor No:
SA Clubman Series	SA Hyundai Series	Have Fun
COMPETITOR (CAR OWNER)
Name:
Street Address:
Suburb:	State:	Postcode:
Telephone: (hm):	(wk)	(mobile)
Email:
CAMS Licence: Number:	Expiry Date:

DRIVER
Name:	Date of Birth:
Street Address:
Suburb:	State:	Postcode:
Telephone: (hm)	(wk)	(mobile)
Email:
Civil Licence Number:	Club:
CAMS Licence: Number:	Type:	Expiry Date:
Emergency Contact Person:	Mobile:
Emergency Contact Person:	Mobile:

CO-DRIVER / NAVIGATOR
Name:	Date of Birth:
Street Address:
Suburb:	State:	Postcode:
Telephone: (hm)	(wk)	(mobile)
Email:
Civil Licence Number:	Club:
CAMS Licence: Number:	Type:	Expiry Date:
Emergency Contact Person:	Mobile:
Emergency Contact Person:	Mobile:

VEHICLE DESCRIPTION
Make:	Model:	Year:
Body Type:	Colour:	Vehicle Log Book No:
Registration Number:	Reg. Expires:
Engine Capacity: cc	Turbo?:	Rotary?:

CLASS
Please tick one:
Class P1	PRC up to 1400cc
Class P2	PRC over 1400cc, up to and including 1600cc
Class P3	PRC over 1600cc, up to and including 2000cc
Class P4	PRC 2WD over 2000cc
Class P5	PRC 4WD over 2000cc (not meeting the requirements of P6)
Class P5S	PRC 4WD over 2000cc (limited modifications - refer SA Conditions)
Class P6	PRC 4WD’s appearing on the list of 4WD’s, refer CAMS Manual
Class H1 & 2	Historic Pre 1968 & Historic 1968 - 1975
Class Classic	Classic Rally Cars
Class All-comers	All-comers Category (Schedule ‘R’)

SERVICE CREW REGISTRATION
DESCRIPTION OF VEHICLE 1
Make:	Model:	Year:
Body Type:	Colour:	Registration Number:	Reg. Expires:
DESCRIPTION OF VEHICLE 2
Make:	Model:	Year:
Body Type:	Colour:	Registration Number:	Reg. Expires:

Official Use Only
Enclosed is CASH / CHEQUE / MONEY ORDER / EFT for the sum of $….……..…. being entry fee for the event.
Form complete Yes / No Date received: ….………........... Documents sighted Yes / No

EXCLUSION OF LIABILITY, RELEASE AND ASSUMPTION OF RISK

COMPETITORS AND/OR COMPETING CREWS IN RALLIES

For Competitors

I/We being the competitor/s of the vehicle described on this Entry Form wish to enter that vehicle for the above event.

For Competitors and competing crew

I/We being the competitor/s and/or driver and/or co-driver and/or navigator, certify that the particulars on this form are true and correct in every particular, to the best of my/our knowledge and belief.

I/We declare that I/we have read and understood the Supplementary Regulations issued for the event, and agree to be bound by them and the provisions of the National Competition Rules of the Confederation of Australian Motor Sport Limited (“CAMS”).

In exchange for being able to attend or participate in the event (including entering the event), I agree:

to release CAMS and Australian Motor Sport Commission Ltd, promoters, sponsor organisations, land owners and lessees, organisers of the event, their respective servants, officials, representatives and agents (collectively, the "Associated Entities") from all liability for my death, personal injury (including burns), psychological trauma, loss or damage (including property damage) ("harm") howsoever arising from my participation in or attendance at the event, except to the extent prohibited by law;

that CAMS and the Associated Entities do not make any warranty, implied or express, that the event services will be provided with due care and skill or that any materials provided in connection with the services will be fit for the purpose for which they are supplied; and

to attend or participate in the event at my own risk.

I/we acknowledge that:

the risks associated with attending or participating in the event include the risk that I may suffer harm as a result of:

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

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 the safety of persons or property at the event.

motor sport is dangerous and that accidents causing harm can and do happen and may happen to me.

the route instructions should not be relied upon exclusively in estimating the degree of severity of any hazard which might be encountered, or the manner in which any section of the road is driven, whether shown in the route instructions or not, and that I/We have been advised to exercise caution in following these route instructions.

I accept the conditions of, and acknowledge the risks arising from, attending or participating in the event and being provided with the event services by CAMS and the Associated Entities.

I/we acknowledge that my/our personal information will be processed in accordance with the CAMS privacy policy which is available from the www.cams.com.au and where I/we suffer from any injury, sickness or death during the Event, I/we consent to the release by health services of my/our personal health information to an authorised representative of CAMS or the Event who may use it in the preparation and release within and outside Australia of accident or incident information and reports to interested parties for the purposes of accident investigation, accident prevention and safety activities, news services including broadcast services, or for the purposes of processing insurance claims.

I understand that this disclaimer is not intended to exclude any valid claim I may have under the CAMS Personal Insurance Scheme.

Competitor's signature: .................................................. Date: ........................................

Driver/s signature: ......................................................... Date: ........................................

Navigator/Co-Driver/s signature: ........................................ Date: ........................................

For persons under the age of 18 years the following parent/guardian consent must be completed.

PARENT/ GUARDIAN CONSENT – PERSONS UNDER 18 YEARS OLD

I …………………………………… of [Address] ………………………………………………… am the parent/ guardian* of the above-named ("the minor") who is under 18 years old. I have read this document and understand its contents, including the exclusion of liability and assumption of risk, and have explained the contents to the minor. I consent to the minor attending/ participating in* the event at his/her own risk.

Signed……………………………………………..

Parent/Guardian*

Date………………………………………

* Delete whichever does not apply

RALLY SERVICE CREW DISCLAIMER - EXCLUSION OF LIABILITY, RELEASE AND ASSUMPTION OF RISK

I/We being a member of/the service crew certify that the particulars on this form are true and correct in every particular, to the best of my/our knowledge and belief.

In exchange for being able to attend or participate in the event, I/we agree:

To release Confederation of Australian Motor Sport Ltd ("CAMS") and Australian Motor Sport Commission Ltd, promoters, sponsor organisations, land owners and lessees, organisers of the event, their respective servants, officials, representatives and agents (collectively, the “Associated Entities”) from all liability for my death, personal injury (including burns), psychological trauma, loss or damage (including property damage) (“harm”) howsoever arising from my participation in or attendance at the event, except to the extent prohibited by law:

That CAMS and the Associated Entities do not make any warranty, implied or express, that the event services will be provided with due care and skill or that any materials provided in connection with the services will be fit for the purpose for which they are supplied: and

To attend or participate in the event at my own risk.

That Service crew members must be over the age of 15 years. Where a person under 18 years is part of a service crew they require parental/ guardian consent and that crew member/s must be under adult supervision at all times.

I/We acknowledge that:

The risks associated with attending of participating in the event include the risk that I may suffer harm as a result of:

Motor vehicles (or parts of them) colliding with other motor vehicles, persons or property:

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 the safety of persons or property at the event.

Motor sport is dangerous and that accidents causing harm can and do happen and may happen to me.

The route/service crew instructions should not be relied upon exclusively in estimating the degree of severity of any hazard which might be encountered, or the manner in which any section of the road is driven, whether shown in the route instructions or not, and that I/we have been advised to exercise caution in following these route/service crew instructions.

I accept the conditions of, and acknowledge the risks arising from, attending or participating in the event and being provided with the event services by CAMS and the Associated Entities.

I/we acknowledge that my/our personal information will be processed in accordance with the CAMS privacy policy which is available from the www.cams.com.au and where I/we suffer from any injury, sickness or death during the Event, I/we consent to the release by health services of my/our personal health information to an authorised representative of CAMS or the Event who may use it in the preparation and release within and outside Australia of accident or incident information and reports to interested parties for the purposes of accident investigation, accident prevention and safety activities, news services including broadcast services, or for the purposes of processing insurance claims.

I understand that this disclaimer is not intended to exclude any valid claim I may have under the CAMS Personal Insurance Scheme.

Car No: …………………Driver’s Name:

Event: Wombat Rallysprint

Name	Address	Signature	Mobile No

For persons under the age of 18 years the following parent/guardian consent must be completed.

PARENT/ GUARDIAN CONSENT – PERSONS UNDER 18 YEARS OLD

I of [Address] am the parent/ guardian* of the above-named ("the minor") who is under 18 years old. I have read this document and understand its contents, including the exclusion of liability and assumption of risk, and have explained the contents to the minor. I consent to the minor attending/ participating in* the event at his/her own risk.

Signed………………………………………………………….

Parent/Guardian*

Date……………………………………

* Delete whichever does not apply

Wombat Rallysprint Entry Form	Page ii of vi

Wombat Rallysprint

Event Entry Form 2009

Dave Rudham

2009-08-27

SARP

CAMS