Today's Date: 23 Sep 2020 - Upon hitting the submit button, this will be recorded as date received.
ENTRY FORM
Southern District Motorsports Association Inc.
Held under the International Sporting Code of the FIA, and the National Competition Rules of MA.
PO Box 1484, Queanbeyan, NSW 2620 (Incorporated in the ACT)
www.sdmhillclimb.com

MA Permit No: 120/0410/01
Event:  SDMA Club Hillclimb        Date:  Sunday 4th of October 2020        Event Location:  Fairbairn Park

NOTE: There are three new sections to the online entry form

  1. Self Scrutiny Checklist

  2. Self Scrutiny statement of compliance, and

  3. Motorsport Australia Disclaimer which includes specific COVID-19 information

The disclaimer it at the bottom of the page and is very long. There is a required checkbox after it to acknowledge your understanding and then there will be a submit button. It is very important you read the MA Disclaimer.

Declaration by Competitor: (NOTE: THIS IS THE CAR OWNER)
Address
Postcode
Being a Financial member of the Southern District Motorsports Association 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.
Drivers Details - It is a MA requirement that this section is filled out correctly - you CAN NOT put "as above"
Name

Address

Postcode

Phone (h)

Phone (w)

Email

Junior Driver

Female Driver

MA Affiliated Car Club
Southern District Motorsport Association (Day membership may be available if you are a member of another MA affiliated Car Club, contact the Event Secretary , listed below, for information
Club Membership No:
(Membership card MUST be sighted at the event - enter NEW if signing up at event)
NOTE: If you are from another MA affiliated club, just put initials of the club - Membership card MUST be sighted at the event.

MA Licence No:

(Licence MUST be sighted at the event - enter NEW if signing up at event - You can find the MA licence form here - a Speed L2S license is required)
   
Description of Vehicle
If driving 2 Vehicles, is this vehicle to be counted towards the drivers Championship?
Yes No (Please complete a separate form if driving a second vehicle, second entries are subject to approval)
   
Is this a new Competition Vehicle?



Make:

Body Type:

Model:

Year:

Engine Capacity: 

  (E.G: if you have a 1.6l - put 1600...if 2.5l put 2500...if 3.8l put 3800)

Fuel Type:


Forced Induction?

Category Type:
  
If you are unsure of the Category Type of your Vehicle, please contact the Event Secretary (Details Below)

Category Class:
 
Your Class will be determined and confirmed in an email

MA log Book No:
 
  (if applicable)

Is this car double entered?



If Yes, please add the name of the second driver below (NOTE: This is not the entry for the second driver - it just ensure the two drivers are split in the running order)


Competition Category Types (summarised, see www.sdmahillclimb.com/entry for full details)
Type 1/2 - Standard or minor modifications   Type 3 - More modified Vehicles   Type 4  - Extensively modified Vehicles   Type 5 - Race Vehicles   Type AE - Electric powered Vehicles
Type AWD 1/2 - AWD, standard or minor modifications   Type AWD/SV 3 - AWD and 2WD kit vehicles, more modified   Type AWD/SV 4 - AWD and 2WD kit vehicles, extensively modified

Classes: Type 1-4 and SV/AWD: 0-1600cc, 1601-2000cc, 2001-3000cc, over 3000cc
Type 5: 0-750cc, 751-1300cc, 1301-2000cc, over 2000cc   Type AE: EV
SELF-SCRUTINY CHECKLIST

By placing a check in each listed item you are providing formal assurance that you have checked that the item is in good working order.

Vehicle General Condition

Vehicle General Safety

Steering System     
Brakes     
Fluid Levels/Leaks     
Battery Secure/Covered     
Exhaust System (condition/noise)     

Throttle Return Spring     
Signage (Comp No., Battery idicator, tow indicator, etc)     
Fuel System (tank, lines, etc.)     
Fire Extinguisher and mounting     
Safety cage and Padding (if applicable)     
Safety Harness (eg: seatbelt) and Mounting     
Interior - condition/no loose items     
Firewall/bulkhead     
Comments Comments

Apparel

Helmet     
Overalls/Outwear     
Footwear     
Goggles/Visor (only for open wheel vehicles)     

Self-Scrutiny Statement of Vehicle Compliance

I being the competitor and/or driver of the vehicle described above and being legally authorised to enter the vehicle described, hereby declare that the vehicle and all related equipment and components for participation in this event shall be presented at all times and in every respect in a condition suitable for use in this activity. I have caused the vehicle to be inspected according to a maintenance schedule which I have developed and declare that it is free from mechanical defects, be they of preparation or structural integrity, that may render the vehicle unsafe for the proposed activity. I acknowledge that where any aspect of the vehicle or related equipment and components is found, by the chief scrutineer,

  • to be in breach of the MA NCRs and/or regulations of the event, or
  • to be subject to a serious mechanical defect

that I may be subject to penalties under the NCR.

By checking the box below I indicate my acceptance of the above declaration.

PRACTISE

Timed practise will be offered the day before the event (Saturday 3rd October) between 11am and 4pm for $25. Only competitors entered into the event can attend practise

Please indicate if you wish to participate

PAYMENT DETAILS
Payment Method:     Cost of this hillclimb event is: $85(Senior) and $50(Junior)
   
NOTE:

Unless a prior arrangement has been made with the event secretary, entry fees for hillclimb events MUST be received into the SDMA bank account before the close of entries. If the fee is not received, your entry will be deemed invalid and your car will not run on the day.



EFT Details BSB: 633000
Account: 153212766
Name: SDMA
Cheque/Money Order/Cash Cheque/Money Order MUST be made payable to SDMA and then forward to: 71 Maitland St Hackett ACT 2902
 
EVENT SECRETARY DETAILS
Name: Dave Peisley
Phone: 0409 000 028
RISK WARNING, DISCLAIMER AND INDEMNITY

Motorsport 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 the Motorsport Activities.

I acknowledge that the risks associated with attending or participating in Motorsport 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;
● other 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 the Motorsport 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 Motorsport 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; and
● to attend at or participate in the Motorsport 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 the Motorsport Activities and Recreational Services;
● nothing in this document prevents Motorsport Australia and 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 Motorsport Australia and 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 for 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 Motorsport Activities. 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 Motorsport 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’s insurance arrangements, this document and my own circumstances.

Where Motorsport Activities are held in the following jurisdictions, I acknowledge that I have also read and accept the following warnings:
Under the Australian Government Consumer Law (which is part of the Competition and Consumer Act 2010 (Commonwealth)), several guarantees are implied
into contracts for the supply of certain goods and services. You agree that the application of all or any of the provisions of Subdivision B of Division 1 of Part
3-2 of the Australian Consumer Law (i.e. guarantees relating to the supply of services), the exercise of rights conferred by those provisions, and an liability of
Motorsport Australia and the Entities for a failure to comply with any such guarantees, are excluded. However, such exclusion is limited to liability for:
● Death, physical or mental injury (including aggravation, acceleration or recurrence of such an injury of the individual);
● Contraction, aggravation or acceleration of a disease of an individual; or
● 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 in
relation to an individual that is or may be harmful or disadvantageous to the individual or the community or that may result in harm or disadvantage to the individual or the community.
This exclusion does not apply to significant personal injury suffered by the reckless conduct of Motorsport Australia and the Entities.

Excluding, Restricting or Modifying Your Rights:
Under section 42 of the Fair Trading Act 1987 (SA), the supplier of recreational services is entitled to ask you to agree to exclude, restrict or modify his or her liability for any
personal injury suffered by you or another person for whom or on whose behalf you are acquiring the services (a third party consumer). If you sign this form, you will be agreeing
to exclude, restrict or modify the supplier’s liability with the result that compensation may not be payable if you or the third party consumer suffer personal injury.

Important:
You do not have to agree to exclude, restrict or modify your rights by signing this form. The supplier may refuse to provide you with the services if you do not agree to exclude, restrict or
modify your rights by signing this form. Even if you sign this form, you may still have further legal rights against the supplier. A child under the age of 18 cannot legally agree to exclude,
restrict or modify his or her rights. A parent or guardian of a child who acquires recreational services for the child cannot legally agree to exclude, restrict or modify the child’s rights.

Agreement to exclude, restrict or modify your rights:
I agree that the liability of Motorsport Australia and the Entities for any personal injury that may result from the supply of the recreational
services that may be suffered by me (or a person for whom or on whose behalf I am acquiring the services) is excluded.
Further information about your rights can be found at www.cbs.sa.gov.au

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.

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.

Declaration

I accept the conditions of, and acknowledge the risks arising from, attending or participating in motorsport 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.

By checking the box below I indicate my acceptance of the above declaration.

By hitting the submit button, you acknowledge all the information entered above is correct. As per MA NCR providing false or misleading information will result in your entry being null and void.  A confirmation email, together with the MA disclaimer will be immediately emailed to you. Please follow the instructions contained within the email.