Runway Health & Safety

Full Name *

Email Address *

Residential Address *

Telephone *

Date of Birth *

Nationality *

Driving Licence Number *

Emergency Contact Number *

Car Make *

Car Model *

Car Year *

Engine Capacity *

Have you ever suffered from or are you currently suffering from any of the following illnesses or conditions

Please add any further information on diabetes, medicines taken (either prescribed or bought over the counter) or any other relevant information below

Any allergies?

Are you on any blood thinning medication? *

I confirm I will bring a helmet, long sleeves and trousers *

No t-shirts / shorts / passengers are allowed during top speed runs. Helmet required - if you don't have one, we have a very limited number available for hire. Please email [email protected]

Yes

I confirm my vehicle is well maintained and has suitable performance tires fitted with legal tread *

Your car will undergo scrutineering checks before runway access is permitted

Yes

Disclaimer

In consideration of being permitted to participate in an event I declare as follows:

That I have read the Codes of Practice and Regulations for NORA 92 Ltd, the Event Regulations and entry form (when applicable) and I agree to be bound by them in every respect. That I am fit and not suffering from any physical or mental disability which would impair my safe participation in the event. I undertake to inform NORA 92 Ltd immediately should any change in my condition occur which I have reason to or ought to have reason to believe would affect my ability to participate in this competition. That I have completed a medical questionnaire form (as requested during your licence application) and that I will inform NORA 92 Ltd should my medical status have changed. As a participant I may be exposed to the risk inherent in motor sport and that I am prepared to take such risks. I further agree that I shall not seek to claim against NORA 92 Ltd, the organisers, their officials, the land owners, the promoter or other bodies or individuals connected with the event(s) in respect of any damage to my property howsoever caused, and whether by negligence or breach of statutory duty of the said bodies or persons. NORA 92 does not provide personal accident insurance other than through annual licences.

I also confirm that:

– The answers given by me in this Licence application are true.
– I fully understand the type of the events which the Licence allows me to enter and the rules and regulations that apply to such events and to competitors and will comply with them.
– I will ensure that before I enter any event, I am competent to compete and that any vehicle that I use is safe and fit for the competition and nature of the course.
– I will satisfy myself (by sighting lap or otherwise) before taking part that the venue and track is acceptable to me with regard to its features and physical layout (unless prohibited to do so).
– I will NOT enter or take part in any competition where I have a doubt as to my safety.
– I will tell you immediately if, for any reason, I believe that I am no longer able to satisfy the terms of this Licence or I become aware that I have become unable to compete due to physical or other disability.
– I agree to accept the risks of injury and death that are inherent in motor sports and agree to take part at my own risk.
– If under the age of 18, my parent / guardian has read the above and signed the declaration and agreement below.
– I agree that my details may be passed to the NORA92 should I be treated on site by the medical team.
– This Event Licence does not come with personal accident insurance cover.

Acceptance of risk *

Signed your full name below if you have read and agree to the disclaimer.

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