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INSTRUCTIONS: Just print this
page out and fill it in. Then, either fax or mail it
in, or bring it with you on the day and you won't have to line up!
Queensland Early Motorcycle Sports Club
Save Lakeside Cruise In Show
DRIVER’S AND RIDER’S INDEMNITY
FORM
WARNING! THIS IS AN IMPORTANT DOCUMENT WHICH AFFECTS YOUR LEGAL RIGHTS AND
OBLIGATIONS. READ IT CAREFULLY AND DO NOT SIGN IT UNLESS YOU ARE SATISFIED YOU
UNDERSTAND IT.
SAVE LAKESIDE CRUISE IN SHOW is run under Motorcycling
Queensland’s Regulations for trail rides.
1.
CONTRACT TO PARTICIPATE IN MOTORCYCLE SPORTING EVENT AND/OR ACTIVITY
I hereby agree
with the persons, organisations and bodies corporate whose names appear in
Schedule 1 (hereafter collectively called “the organiser”) that I am by this
agreement entitled to participate in the SAVE LAKESIDE CRUISE IN SHOW
(hereinafter called “the meeting”) held on 12 AUGUST,
2007 at MT COOT-THA BOTANICAL GARDENS, TRANSIT TO, AND LOT 4 LAKESIDE RD,
KURWONGBAH (hereinafter called “the venue”) on the terms and conditions set out
in this document.
2.
ACKNOWLEDGEMENT OF RISKS, DANGERS AND OBLIGATIONS
I acknowledge that
motorcycling sport is dangerous and that by engaging in the sport and
participating in this meeting I take and am exposed to certain risks and dangers
and am under certain obligation as follows:
a)
that I may be injured, physically or mentally, and may be
killed;
b)
that my machinery or equipment may be damaged, lost or
destroyed;
c)
that other riders may ride dangerously or with lack of skill;
d)
that track or event conditions may be hazardous and may vary
without warning or predictability;
e)
that organisers, officials, landowners/track operators and
any agents or representatives of those in charge of meetings are frequently
obliged to make decisions under pressure of time and/or events;
f)
that any policy of insurance of or in respect of my life or
physical or mental health may be avoided;
g)
that there may be no or inadequate facilities for treatment
or transport of me if I am injured;
h)
that I have an obligation to myself and to others to
participate safely and within the rules of this meeting.
3.
INDEMNITY GIVEN TO ORGANISERS
In consideration
of the acceptance of me as an entrant in this meeting I AGREE TO INDEMNIFY the
organisers and each of them in the following manner:
a)
that I participate in this meeting at my sole risk and
responsibility;
b)
that I accept the venue as it stands with all or any defects
hidden or exposed;
c)
that I indemnify and hold harmless the organisers, their
respective servants, agents or officials against any actions or claims which may
be made by me or on my behalf or by other parties for or in respect of or
arising out of my death or any injury, loss or damage caused to me or to my
machinery or equipment, whether caused by negligence, breach of contract or in
any other manner whatsoever.
4.
SCRUTINEERING DECLARATION
I declare that my
machine is safe for use in the SAVE LAKESIDE CRUISE IN SHOW. I declare that the
brakes, suspension, steering and exhaust system of my machine are working
effectively and that it has no external oil leaks.
I acknowledge that
my machine may be subjected to random scrutineering checks and that I may be
required to repair or cease using my machine if it is found unsafe or
unacceptable for any reason.
SCHEDULE 1 1. Federation Internationale Motorcycliste
2. Motorcycling Australia
Ltd
3. Motorcycling
Queensland
4.
Queensland Early
Motorcycle Sports Club and Lakeside Motor Racing Enthusiasts, Inc.
5.
Brisbane City
Council and Chris Sexton
SURNAME:
................................................................. GIVEN
NAMES:..................................................................
ADDRESS:
..............................................................................................................................................................
SUBURB:
..................................................................................................
POSTCODE: ........................................
PHONE (Home or
Mobile): ............................................ DATE OF BIRTH:
......................... GENDER: Male / Female
(Please circle)
NEXT OF KIN /
EMERGENCY CONTACT:
..............................................................................................................
SIGNED:
........................................... SIGNATURE OF GUARDIAN (IF UNDER
18): ...........................................
MAQ PERMIT #
38442
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