Surname: Christian Name(S): . .

Surname: ………………………………………………………Christian Name(s):...……..………………….…………….….……..…

Address:……………………………………………………………………………………………………………..…..P/Code:……………….….……

Date of Birth:……………/……………./………………..Occupation: ………………………………………………………….…….

Phone: Home:…………………….Mobile: …………………….Business:…………………….Email: …………………………….………...

Kart Number: …………………………Class: ……………………………………………………………………………………………………………

Sponsor: ………………………………………………………………………………………………………………………………………………………

AIDKA Licence Number(CURRENT OR PREVIOUS):…………………………………………………………………………or New Member:

Do you hold a current First Aid Certificate?YES NO

AIDKA LICENCES ALL CATEGORIES FOR 2017 SEASON ARE AVAILABLE ON AIDKA WEBSITE ONLY.THIS APPLICATION IS FOR CLUB MEMBERSHIP ONLY. LICENCES WILL ONLY BE ISSUED BY AIDKA ONCE THE CLUB HAS RECEIVED PAYMENT FOR MEMBERSHIP.

AIDKA WEBSITE:

MEMBERSHIP CATEGORIES
FAMILY
$75.00 / TICK IF COVERED BY FAMILY MEMBERSHIP / SENIOR
$47.00 / JUNIOR
$20.00 / LIFE MEMBER
NIL FEE

I the undersignedunderstand that go-kart racing can be dangerous, and undertake this sport completely at own risk. I shall not hold Angas Go-Kart Club Inc., Committee or Club Members liable for any injuries that may be sustainedat an authorised event. Any loss or damage to equipment and/or personal belongings will be at my own risk. The Angas Go Kart Club Inc. Code of Conduct has been received and understood.

I the undersigned accept the conditions as set out on this form and all statements are true and correct.

 MUST BE SIGNED BY THE APPLICANT:………………………………………………….………Date:…….…../……..…./2017

 IF UNDER 16 PARENT/GUARDIAN SIGNATURE: …..………………………………………….Date……..…./……….…./2017

PLEASE RETURN MEMBERSHIP FORM Mr David Earl

WITH YOUR PAYMENT TO:13 Hesperus St, Hallett Cove SA 5158 Phone 0417 331 102

E-mail:

DIRECT PAYMENT TO: ANGAS GO KART CLUB INC.BSB: 035:088Westpac ACCOUNT: 148500

------CLUB USE ONLY------

Date Received ………/………/2017 Cash Cheque Money Ord Direct Payment:

Amount Received:$...... DateEntered in Records….…../…..…./ 2017

PLEASE COMPLETE AND RETURN BOTH PAGES (MEMBERSHIP FORM & CODE OF CONDUCT.

ANGAS GO-KART CLUB INC

STRATHALBYN, SOUTH AUSTRALIA

2017 CODE of CONDUCT

SAFETY POLICY DOCUMENT

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Angas Go Kart Club provides a high standard for a safe environment for all members and visitors on its grounds, and as such the following form must be signed by an Adult (any person over the 18 years) before membership will be issued.

SAFETY & EMERGENCY PROCEDURES

In the event of any emergency all club members and visitors are to evacuate via the shortest and safest route as directed by club official(s) and assemble at the evacuation point:

CAR PARK AREA ADJACENT TO TICKET BOX ENTRANCE.

ENVIRONMENT

All persons whether a member or visitor at the Angas Go Kart Club Inc. facilities shall comply with SA Environmental Act 1993. A person must not undertake any activity that shall pollute the environment unless the person takes all reasonable and practical measures to prevent or minimize any resulting harm.

I have read and understood the information in this document and will take all reasonable care to carry out my responsibility to ensure a high standard of safety is achieved while at the Angas Go Kart Club Inc.facilities

CODE OF CONDUCT

All Club Members and Visitors who have any children under the age of sixteen (16) are required to supervise and control their behaviour while on the club premises. Any child who is unsupervised, or behaving in an unacceptable or abusive manner or participating in dangerous activities as considered by the club will be asked to leave the premises with their parents or guardian.

Any Senior Member or Visitor who is deemed to be behaving in an unacceptable or abusive manner or participating in dangerous activities as considered by the club will be asked to leave the premises immediately.

All Club Members and visitors will be required to carry out all activities associated with Go Kart Racing in a safe and responsible manner, and does so entirely at their own risk.

Any person who desires to have a novice drive at Angas Go Kart Club Inc. must wear personal protective clothing and an approved helmet as required by AIDKA Rule Book (2015-2016), (Protective Clothing), and must also be covered by ambulance cover.

It is also the responsibility of the licence driver who allows their kart to be used by a novice driver, that the driver is covered by ambulance cover, and is also to ensure that all safety apparel equipment worn by the novice driver is in good condition. All karts must be scrutineered before they are placed on the grid.

Print Full Name: …………………………………………………………………………….…………………………………

Applicant Signature……...……………………………………………………………………………………………………

Dated / / 2017