Entry Form

ENTRY FORM

2020 Targa City Sprint Entry Form

Please complete this form with all relevant details correctly formatted to ensure your entry is received.
Supp Regs can be downloaded from:
www.targacitysprint.com.au/noticeboard/

 

DRIVER DETAILS

Please provide the Name and Mobile number for your next of kin in the event of an emergency.

VEHICLE

SPONSOR & CAR DETAILS

List one Sponsor to be named in lieu of the Entrant on the Entry List / Start Order etc. If not provided then the Entrant will be listed.
Please select which class your vehicle belongs to. Note: Don't forget to include the 'equivalence' factor for Turbo/Supercharged/Rotary vehciles when selecting the correct class.

PAYMENT

PAYMENT DETAILS

Reminder: Your Entry Fee must be received in full prior to close of entries in order for your entry to be accepted.

Please advise the business name should you require a Tax Invoice to be supplied. Leave blank if an invoice is not required.

$200

Please select your preferred payment method.

BSB: 066-160
Account #: 10484606
Ref: TCS & Drivers Surname

Please email admin@targawest.com.au to arrange a Credit Card Payment.

Please note a 1.5% Admin Fee applies to all Credit Card payments.

SHANNONS

Shannons Insurance have a ever expanding portfolio of insurance products including Car, Bike & Home Insurance.

See www.shannons.com.au or call 13 46 46.

Shannons are fantastic supporters of motorsport in general but in particular of our Targa West, the Targa Rallysprint Series and all our other Targa West events.

We would encourage you to support those that support us.

Please indicate below whether you would like someone from Shannons to contact you to discuss your Car or Home Insurance needs.

HEALTHWAY ACKNOWLEGEMENT

Targa West are committed to creating a healthier tarmac rally community and proudly promote Make Smoking History in association with Targa West events.

By participating in the event I confirm that ;

  • my car does not contain any tobacco branding, including but not limited to colour scheme/theme, logos, insignia, text.
  • our team wear including driving suits, helmets, shoes, hats, shirts etc does not contain any tobacco branding, including but not limited to colour scheme/theme, logos, insignia, text.
  • our team, including, driver, co-driver and all support/service crew, will not promote tobacco products or smoking and are aware of the Targa West Non Smoking policy

Note: Historic or Classic cars replicating colour schemes of the era may, upon application, be approved by the organisers on a case by case basis. Please seek permission (email: admin@targawest.com.au) prior to completing your entry.

MOTORSPORT AUSTRALIA DISCLAIMER

RISK WARNING AND DISCLAIMER 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 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 and Indemnity In exchange for being able to attend or participate in 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;
  • to be bound to the rules, regulations and policies of the Entities; 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 Motor Sport Activities and 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.

Definitions: a. “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; b. “Entities” means event and competition organisers/promoters/managers, land and track owners/managers/administrators/lessees, Motorsport Australia affiliated clubs, state and territory governments and insureds listed in Motorsport Australia’s 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; c. “Motorsport Activities” means any motorsport activities or Recreational Services which are permitted or approved which Motorsport Australia regulates or administers or otherwise are under the responsibility / control of Motorsport Australia; d. “Motorsport Australia” means the Confederation of Australia Motor Sport Ltd. trading as 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.

COVID-19 DECLARATION: I declare that I:

  • have not been diagnosed with COVID-19 as confirmed with a positive test for COVID-19 (not antibody test);
  • am not currently experiencing any symptoms of COVID-19;
  • have not been in contact with a known COVID-19 positive case in the previous 14 days; and
  • have not been overseas or have been in contact with someone who has been overseas in the previous 14 days.

If after submitting this form I do come into contact with someone with COVID-19 or if I start to exhibit any of the symptoms or signs indicating that I may be infected, I will immediately withdraw from the Event, notify Motorsport Australia in conjunction with the Event Organiser and ensure that my close contacts also do not attend. Should I become ill at or start to exhibit COVID-19 symptoms at the Event I shall withdraw safely and immediately notify the Event Organiser, including identification of those others who I have come into contact with at the Event. I declare, acknowledge and accept that I will comply with all Government and Motorsport Australia requirements imposed in respect of COVID-19. I understand that Motorsport Australia guidance on COVID-19 in relation to Events has Regulatory status and is applied in conjunction with the Motorsport Australia National Competition Rules (NCR). Breach of this obligation may lead to disciplinary action being taken. I understand and agree that my personal data is being processed solely for the purposes of running this Event and may be used for the purposes of COVID-19 infection tracing and will be handled by the organisers in accordance with Motorsport Australia policy.

ANY APPLICANT MAKING A FALSE DECLARATION IS LIABLE TO REFUSAL AND CANCELLATION OF LICENCE AND/OR INSURANCE COVER. I accept the conditions of, and acknowledge the risks arising from, attending or participating in Motor Sport 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 above including the exclusion of statutory guarantees, warning, assumption of risk, release and indemnity

SUBMIT ENTRY

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