Please complete the following attendance and participation registration and disclaimer form with

details of your drivers licence or valid form of identication. Please send a signed and completed
form to rush@xoticar.com.au.
FULL NAME: ............................................................................................................................
DATE OF BIRTH: ......................................................... Male Female
PHONE:.....................................................................................................................................
Are you participating in some track time? ...................... Yes No
If YES, please ll in these details:
Car type: ..................................................................... Man Auto
Drivers Licence No: ............................. Exp Date: ...........................Class of Licence: ...................
How many years have you been driving? ......................................................................................
Have you experienced any track time before? ...............................................................................
Have you had any defensive driving courses? When? ....................................................................
GUESTS COMING
1. NAME ............................................................................... AGE .............................................
2. NAME ............................................................................... AGE .............................................
3. NAME ............................................................................... AGE .............................................
4. NAME ............................................................................... AGE .............................................
Important Notes

Arrival time is 9.30am sharp to attend the safety brieng and track layout presentation.
If you do not attend the safety brieng, you will NOT be allowed on the track.

Helmets are compulsory. If you have your own helmet, please bring it along, otherwise a helmet
will be supplied. *Personal helmets must have Australian standards sticker visible.

Long cotton pants, long sleeved cotton shirt, and enclosed shoes are a requirement to race.
RUSH
E N T R Y F O R M 28TH SEPTEMBER 2014
RUSH E N T R Y F O R M
For the purposes of this disclaimer XOTICAR, RAC and their related entities, promoters, sponsor organisations,
land owners and lessees, organisers of the event, together with their respective employees, directors, contractors,
representatives and agents are not liable for any loss, damage, injury or death to person or property occurring at
the event as a result of any motor or entertainment display accidents or any other events whatsoever, whether or not
the loss, damage or injury is due or alleged to be due to negligence or misconduct of participants and attendees,
XOTICAR, RAC, or a third party.
Motorsport is dangerous and spectators attending this event do so entirely at their own risk. It is a condition of entry
that all persons attending this event are absolved from all liability arising out of any accidents causing damage or
personal injury or death to spectators, drivers or passengers, except where due care has not been exercised. It is
accepted that under no circumstances should spectators enter the track area at any time during the event.
I, being the individual described on page 1 of this Participant Registration and Disclaimer Form (Participant), and
taking part in the event specied on page 1 acknowledge, declare and agree:
1 To obey the directions of the facilitators, trainers, organisers, or any other persons nominated by XOTICAR and RAC
to instruct or otherwise control the event, and to abide by all regulations, rules and procedures communicated to me at
all times;
2 To (i) drive in a safe and responsible manner at all times;
(ii) abide by applicable road rules;
(iii) be responsible for the safety of the vehicle(s) I am driving;
(iv) be responsible for the safety of any passengers in the vehicle I am driving
3 Motoring activities are inherently dangerous and notwithstanding the exercise of care and skill by RAC, accidents
causing death, bodily injury and property damage can and do happen;
4 Whilst XOTICAR and RAC guarantees that the services it provides at the event will be provided with due care
and skill and will be t for purpose, to the extent permitted by law (pursuant to Australian Consumer Law), no other
warranties or guarantees are provided to me in respect of the services, whether expressed or implied;
5 To the maximum extent permitted by law, XOTICAR and RAC will not be held responsible or liable whether in
negligence, contract or otherwise if any person (including myself) incurs, experiences or suffers any accident,
direct or indirect loss (including but not limited to any loss suffered to property or person and economic loss),
damage, fatality, injury (including psychological trauma and burns), inconvenience or health related issue
whatsoever arising out of or connected to my participation at the event or course;
6 That if I do not observe or follow the obligations imposed on me, I fully and nally release and discharge XOTICAR
and RAC from any liability, claim, action, right, entitlement, expense or cost I may have or incur arising out of my
conduct, acts or omissions at or connected to the event or course;
7 By participating in the event or course my person and property may not be covered by my private contracts of
insurance;
8 That I have been advised by XOTICAR and RAC of the licence requirements for participating in the event and, if
applicable, I hold a current and valid licence that allows me to legally participate in the event.
9 That, notwithstanding the terms of clause 8 above, I will not participate in any activity in the event for which I do not
hold a required licence to legally participate;
10 At no time during my participation at the event will I be under the inuence of any drugs, alcohol or anything else
that may affect my ability to drive or passenger a motor vehicle;
11 I do not have any known medical conditions and am not taking any medication that may affect my ability to drive or
passenger a motor vehicle or for which I have been advised not to drive or be a passenger;
12 Where applicable, my motor vehicle/s is/are registered and road worthy;
13 Without prejudice to the positive obligations in clause 2 above, that I will not act, or omit to act, in any manner that
is dangerous or unsafe at any time; and
14 I will immediately advise the relevant driver trainer or instructor of any changes in mine or the vehicles
circumstances if and when it occurs during this event.
Drivers Signature .................................................... Print Name ...........................................
Date .......................................................................... Date ......................................................
Disclaimer of liability - Important Notice
Whilst activities at our centre are supervised by fully qualied staff and undertaken with due care and skill, driving
activities are dangerous. There are protections you are afforded by law. Please read the below disclaimer carefully to
understand your rights and responsibilities.