2012 Quit Forest Rally – 30 March to 1 April, 2012 – Busselton & Nannup, WA
Event Secretary: David Smith; 17 Virgilia Way, Forrestfield, WA 6058; Email: firstname.lastname@example.org Mob: 0419 894 555
Promoter: West Australian Car Club (Inc.) ABN: 22 710 686 402
1. Applicant Details:
Competitor / Entrant:
Driver Name: Co-Driver Name:
2. Time & Location:
Test Session Date / Time: Wednesday, 28th March 2012. 0800-1200hrs and 1300-1700hrs. A maximum of 8hrs testing per Driver is permitted.
Location of Test Stage: Brockman Road (cnr Brockman Hwy, 1.8km South-East of Nannup)
0800hrs–1200hrs Shared Half Day @ $480
Tick Preferred Session: or 1500hrs–1700hrs Shared Part Day @ $240
(Max of 8 hrs testing per Driver)
1300hrs–1700hrs Shared Half Day @ $480
In exchange for being able to attend or participate in the event (including acting as a service crew at the event), I/we agree:
to release CAMS and Australian Motor Sport Commission Ltd, promoters, sponsor organisations, land owners and
lessees, organisers of the event, their respective servants, officials, representatives and agents (collectively, the
"Associated Entities") from all liability for my death, personal injury (including burns), psychological trauma, loss or
damage (including property damage) ("harm") howsoever arising from my participation in or attendance at the
event, except to the extent prohibited by law;
that CAMS and the Associated Entities do not make any warranty, implied or express, that the event services will be
provided with due care and skill or that any materials provided in connection with the services will be fit for the
purpose for which they are supplied; and
to attend or participate in the event at my own risk.
I/We agree acknowledge that;
the risks associated with attending or participating in the event include the risk that I may suffer harm as a result of:
motor vehicles (or parts of them) colliding with other motor vehicles, persons or property;
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 the safety of
persons or property at the event.
motor sport is dangerous and that accidents causing harm can and do happen and may happen to me.
I accept the conditions of, and acknowledge the risks arising from, attending or participating in the event and being provided
with the event services by CAMS and the Associated Entities.
I understand that this disclaimer is not intended to exclude any valid claim I may have under the CAMS Personal Insurance
I/We acknowledge that all persons travelling in a competition vehicle (other than the Driver and Co-Driver) are required to
sign the CAMS approved Passenger Disclaimer. (A copy of this Disclaimer is available from the Rally Office).
I/We acknowledge that all persons associated with the team and who are attending the test session (other than the Driver
and Co-Driver and service crew who are entered/registered at this event) are required to sign the CAMS approved
Disclaimer. (A copy of this Disclaimer is available from the Rally Office).
Competitor / Entrant Signature: Date:
The Quit Forest Rally is a SMOKE FREE event