ENTRY FORM
Historic Sports and Racing Car Association Inc.
Held under the International Sporting Code of the FIA, and the National Competition Rules of CAMS.
HSRCA PO Box 5063 Turramurra South NSW 2074
CAMS Permit No: TBA
Event:HSRCA HillclimbDate: 22nd March 2015Location:Ringwood Park Hillclimb
Entry Fee:Adult $110 inc. GST Entries Close:6.00 pm Tuesday 10th March 2015
Late entries cannot be accepted. Each Driver is to complete a separate Entry Form
Declaration by Competitor: I, …………….………………………………………………………..…….………………...…. of
Address …………………………………………………………………………………..……………… Postcode ………………
Being a financial member of the Historic Sports and Racing Car Association(HSRCA) and being the owner of the car described below, hereby enter my car for the above event and agree to be bound by the rules thereon which I agree, govern the event.
Driver Details:
Name ……………………………………….…………………………………………………………………………………………
Address ……………………………………………………………………………………………..…… Postcode ………………
Phone (h)…………………….……… (w)………….………………Email: ………………..………………………………………
CAMS Affiliated Car Club name:HSRCA (Day Membership may be available if you are a member of another CAMS Affiliated Car Club, contact the Event Secretary, listed below, for information.)
Club Membership No: (HSRCA) ………………………………… (Membership card must be sighted at the event)
CAMS Licence Type ……………………………………………
CAMS Licence No. ……………………………………………… (Licensemust be sighted at the event)
Description of Vehicle –
Make: …………………….……………... Body type: ……………Model: …….…………...………. Year: ..………...……
Engine Capacity: ………………cc CAMS Log Book No. ………………………...
Group : ……..………………
Note: Vehicles will be classified at the organiser's discretion.
ENTRIES and payment are to be forwarded to the address below:
All Monies are to be paid before the Close of Entries.
If you withdraw before 5pmFriday __th March (7 days before event date) a full refund will be given
Cheque / Money Orders: Please make payable to“HSRCA”
Bank Transfer : Bank Commonwealth: BSB:062 205 Acc:1000 7952 Name:HSRCA
(Please supply evidence of payment with entry form)
Entry Forms can be mailed to:HSRCA PO Box 5063 Turramurra South NSW 2074
For further enquiries please contact Wes Dayton by email at or on (02) 9988 4743
The Event Secretary is Judith Raeand can be contacted by email r on (02)4944 7356
OFFICE USE ONLY / DATE MONEY REC’D / AMOUNT PAID $ / CASHCHEQUE
MONEY ORDER
EFT
DISCLAIMER
EXCLUSION OF LIABILITY, RELEASE AND ASSUMPTION OF RISK
COMPETITORS AND/OR DRIVERS
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 Drivers
I/We being the competitor/s and/or driver, 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.
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 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: ......
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. Ihave 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
Issued by the Event Secretary
Historic Sports and Racing Car Association of NSW Inc / Event Secretary Approval
COMPETITOR / DRIVER…………………………………………..……….………. / COMPETITION No. ..………….... / ……………..
LOG BOOK No.…………………………………..
VEHICLE MAKE ……………………………………….. / MODEL …………………………………………….
GROUP …………………………………….. / CAPACITY …………………………………………
All vehicles to be presented in a ready to compete condition
This Scrutiny Form is tailored for single vehicle Speed Events. See event Supplementary Regulationsfor other conditions. Disclaimer: The following list is an inspection guide only and does not cover all issues of safety.
Approved Helmet(AS 1698 minimum)Inspect for damage / Open vehicles to have Visor or Goggles,
plus Gloves in leather or Nomex
Fire Extinguisher
Must be capable of removal by the driver (or crew
where applicable) without the use of tools
Cabin mounted recommended / Seats
Secure Mounting
Blue Triangle
of sides150 mm to indicate Battery position.
If fitted with a remote Battery isolation switch -> requires another blue triangle with a symbol of spark / Seat Belt / Harness
Condition / expiry / securely mounted
Steering & Suspension
Check for Excessive Play in Steering Box & Wheel, Tie Rods & ends, Wheel Bearings, Ball joints. / Throttle Return Springs
Double for carburetor. Each throttle shaft to have a spring. Positive Return at pedal.
Body
No excessive body damage or rust / Rims / Tyres
Condition, Nuts
Battery
Firmly Clamped
Positive terminal cover recommended / Firewall
Holes / Seals / Rear firewall if applicable
Leaks - Oil / Coolant / Fuel / Oil catch tank
(required if engine ventedto atmosphere)
Bonnet Catch / Boot
Two latch system on bonnet / Windscreen
Brakes
Pedal pressure maintained / Exhaust System
Recommended – Tow Hooks Front & Rear
REJECTED:PASSED:
Scrutineer’s Comments:
Permission to CompeteThis is to certify that Car No..………….... / ……………..has passed scrutineering.
Category: / Type…………………………………………… / Capacity…………………………………………………..
Scrutineer’s Signature ………………………………………………