The details on this form will be held on computer in order to be used for the administration of this event. They will also be used to send you information about future events organised by this club, unless you untick this box to indicate you do not wish to receive information on further events.
The details on this form may also be passed on to other motorsport organisations, unless you untick this box to indicate you do not wish these details passed on.

Declaration of Indemnity

I declare that:

1. I have been given an opportunity to read the General Regulations of the Motor Sports Association and, if any, the
Supplementary Regulations for this event and agree to be bound by them. I declare that I am physically and mentally fit
to take part in the event and I am competent to do so. I acknowledge that I understand the nature and type of the
competition and the potential risk inherent with motor sport and agree to accept that risk.

2. The use of the vehicle hereby entered will be covered by insurance as required by the law which is valid for such part
of this event as shall take place on the roads defined by the law.

3. I understand that should I at the time of this event be suffering from any disability whether permanent or temporary
which is likely to affect prejudicially my normal control of the vehicle, I may not take part unless I have declared such
disability to the ASN who have, following such declaration, issued a licence which permits me to do so.

4. Any application form for a licence which was signed by a person under the age of 18 years was countersigned by
that person’s parent/guardian/guarantor, whose names and addresses have been given.

5. If I am the parent/guardian/guarantor of the driver “I understand that I shall have the right to be present during any
procedure being carried out under the Supplementary Regulations issued for this event and the General Regulations of
the MSA. As the Parent/Guarantor “I can confirm that I have acquainted myself with the MSA General Regulations,
agree to pay any appropriate charges and fees pursuant to those Regulations (to include any appendices thereto) and
hereby agree to be bound by those Regulations and submit myself without reserve to the consequences resulting from
those Regulations (and any subsequent alteration thereof). Further, I agree to pay as liquidated damages any fines
imposed upon me up to the maxima set out in MSA General Regulations Part 3, Appendix 1”

Note: Where the parent/guardian/guarantor of the driver is not present there must be a representative who must
produce a written and signed authorisation to so act from the parent/guardian/guarantor as appropriate.