INDEMNITY FORM

 

FOR NON LICENSED, NON MEMBER DRIVERS

USING THE WELLINGTON KART CLUB’S

TRACK AND FACILITIES

 

 

I ________________________________________________________     (first name and family name)

HEREBY AGREE to fully indemnify the Association known as the FIA, the RAC, the NZKF, the WPKA, the Wellington Kart Club Inc, the Upper Hutt City Council, the Wellington Regional Council, all sponsors, and all or any members, officials, assistants or employees of the above named or known organisations against any injury or accident to myself or damage done to equipment or property in my care.

 

Minors (under 18) must have parental or guardians signature approving this indemnity.

 

 

I agree to abide by any instructions given by officials of the Wellington Kart Club and to wear a safety helmet, gloves and clothing which all comply with the NZKF rules.

 

This indemnity is valid for one day of track use only.        Date : __________________________

 

 

I would like to receive further information about                              o

karting and the Wellington Kart Club.

 

 

Address     _____________________________________________________________________________

 

                  _____________________________________________________________________________

 

                  _____________________________________________________________________________

 

 

Telephone  (____)______________________________

 

 

Signed :      _____________________________________

 

Signed by

parent/Guardian   ______________________________________     Age (if under 18)  _____________

   (if applicable)

 

 

Name of organisation/member

who organised your trial laps :  ____________________________________________________________________________

 

 

Please return this signed indemnity to:   Secretary, Wellington Kart Club, P O Box 38 484

                                                               Te Puni Mail Centre, Wellington  Ph (04) 564 7114