Dirt Karting Entry Form

    ZONE 7 DIRT KARTING CLUB CHAMPIONSHIP ROUND 5

    14 August 2021


    Info: Vicki Laubscher (Race secretary)
    Cellphone: 084 296 6873
    Email: admin@zone7.co.za

    Chairman:
    Johan van Zyl (Oom Tonkies)
    Cell: 071 493-2449
    Email: ftdengineering@gmail.com

    Vice-Chairman:
    TBC

    Promoter:
    Johann Spies
    Email: johann@zone7.co.za


    PERSONAL DETAILS

    First Name *

    Last Name *

    ID Number *

    Email Address *

    Cellphone Number *

    Address

    Go Kart Number *

    Club *

    Class *
    Junior NewbiesJunior 160cc/200cc StandardJunior 160cc/200cc PRO270cc Class300cc Class390cc Standard Ladies390cc Standard390cc ModifiedsSupermodsWings 300ccWings Class AWings Class BBeetles
    I have competed in more than 3 events *
    YesNo

    PIT MECHANICS (Max 5 – R 25.00 ea)

    Pitmac 1: Full Name

    Pitmac 1: ID Number

    Pitmac 1: Cell Number


    Pitmac 2: Full Name

    Pitmac 2: ID Number

    Pitmac 2: Cell Number


    Pitmac 3: Full Name

    Pitmac 3: ID Number

    Pitmac 3: Cell Number


    Pitmac 4: Full Name

    Pitmac 4: ID Number

    Pitmac 4: Cell Number


    Pitmac 5: Full Name

    Pitmac 5: ID Number

    Pitmac 5: Cell Number

    MEDICAL & EMERGENCY

    Medical Cover
    YesNo
    Name of Emergency Contact *

    Emergency Contact Number *

    CLUB MEMBERSHIP
    Club Membership Number *

    Declaration

    I signify my/our agreement to abide by the rules by submitting this entry form. I, the lawful parent/guardian of the above-mentioned competitor, do hereby grant permission for him/her to ride in the above-mentioned event. If a competitor is a minor, this form must be submitted by the appropriate parent or guardian.

    Indemnity

    I Acknowledge that motorsport is dangerous. By entering Zone 7 Speedspot Cape Town and using the facilities, I acknowledge the inherit dangers associated with this sport and therefor indemnify the owners, organizers and staff.

    I also indemnify the owners, organizers and staff on behalf of all non-riders and minors in my care. Therefor I utilize the facility on my own risk.

    Indemnity Declaration *
    I am 18 years or older, if not, authorised by a parent/guardian


    EFT PAYMENTs

    Entry Fee: R 275.00 – Members
                       R 225.00 – 2nd Family Member
                       R 325.00 – NON Members
                        R 25.00 – PER Pitmac

    Zone 7 Dirt Karting
    Capitec Bank
    Branch Code: 47 00 10
    Acc #: 1344612960
    Reference: Name and Surname

    Please email relevant documents to info@zone7.co.za.

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