Please fill out this form

And either bring it on the day

or email back to us.

nkarl@kic.org.nz

***DRIVER ONLY***

CIRCUIT HIRE AGREEMENT AND INDEMNITY

Date of Hire…4^th January 2009…………………….……... 

Full Name of

Authorised Driver:………………………………………………………….………………………

Address:……………………………………………………………………………………………..

Make of Car/Truck:……………………………….Phone:……………………..…………

WOF Expiry Date:………………………………………..Fax:……………………………………

Registration Expiry Date:………………………………Racing:……………………………….

Driver’s Licence:…………………………… or Race Licence:………………………………..

TO:       Pukekohe Park Ltd

I, the above hirer and authorised driver, request your permission to Hire the Pukekohe Motor Racing Circuit and to drive only the above vehicle on the circuit and in consideration of such permission I jointly and severally agree to pay the hire fee and to save harmless and keep indemnified both you and the Counties Racing Club Inc and the servants, officials, representatives and agents of you both from and against all actions, claims, costs, expenses and demands in respect of death, injury, loss or damage to person or property howsoever caused arising our of or in connection with my use of the circuit including claims by third parties whether in contact or in tort notwithstanding that the same may have been contributed to or occasioned by the fault or negligence of you or any third party.

I confirm that:

1) The above details are true and correct.

2) y licence has not been endorsed for any reasons.

3) I am not suffering from any disability or health condition, which could affect my driving ability.

4) i have not been convicted of any driving offence relating to reckless or dangerous use of a vehicle.

I AGREE that during our use of the circuit:

a)  i will comply with the instructions of the circuit manager.

b)I will not enter on the circuit without first obtaining permission from the circuit manager.

c)I will exercise due care at all times when on the circuit and understand that reckless or dangerous driving will result in our being prohibited from the circuit.

d)I will not allow any person other than the authorised driver to drive the vehicle.

e)I will not race against any other vehicle on the circuit.

f)I will be responsible for and will pay you to make good any damage I cause to any property of Pukekohe Park Ltd or Counties Racing Club Inc whether situated on the circuit or within its environs.

NOTE:  I accept that there are NO refunds, no exceptions.

      Accepted by Pukekohe Park Ltd                                         Signature of Authorised

……………………………………………………                   …………………………………………………………..

2009 registration form for drivers and cars.

Name……………………………………………..

Make of car/ truck……………………………

Model…………………………………………….

Contact #…………………………………………

Vehicle for rides……Yes / No…………………..

There will be a $50.00 registration cost – this will cover your registration for the day, track time and associated costs – please note that this registration fee is a 100% donation to Camp Quality

You can either post  / e-mail this form back to me to with your registration fee to secure your position on the day.

If you are e-mailing your registration form then the fee is payable on the day 

If you vehicle is to be used for a static display, please advise myself as we need to accommodate for all these means of vehicles IE: car, bike, truck etc.

Contact: Nigel Karl

nkarl@kic.org.nz

 027-235-8470 – 09-2678-555.

Thank you all, and I hope to see you all at Pukekohe Park on the 4^th January 2009.