Wiscombe 500 Owners 11th May 2024 - Woolbridge Motor Club

Motorsport UK Declaration - Car event,
Organising Club - Woolbridge Motor Club Ltd.
Permit Number - tba Event Name - Wiscombe 500 Owners Hillclimb 11th May 2024.

All Officials and Marshals who volunteer at an Event must identify themselves by signing on in order to obtain Personal Accident Insurance cover. They must also sign the following undertaking:

I agree to act in an official capacity at this Event and in consideration of this the Organising Club(s) have effected for my benefit a Personal Accident Insurance Policy for death or benefits as prescribed more specifically by the ASN.

I have been given an opportunity to read the General Regulations of Motorsport UK and, if any, the Official Documents for this Event and agree to be bound by them.

I declare that I am physically and mentally fit to carry out my duties and that I do not have any disabilities or mental health conditions that may affect my ability to carry out my duties. I declare that I have not consumed any substance which may adversely affect my ability to carry out my duties. I will inform the Organisers immediately should any change in my condition occur which I may have reason to believe would affect my ability to carry out my duties.

I acknowledge that I understand the nature and type of Competition and that I may be exposed to the potential risk and dangers inherent in motor sport and I will undertake my duties with their associated risks with due and proper regard for my safety and that of others.

Further, I understand that all persons having any connection with the promotion and / or organisation and / or conduct of the Event are insured against loss or injury caused through negligence.

I hereby agree to abide by all ASN Codes, Guidelines and Policies and where applicable those of the FIA.

I understand that my personal data is being processed and retained by the Organisers and Motorsport UK solely for the purposes of running this Event and will be handled in accordance with the Motorsport UK Data Protection Policy which can be found at www.motorsportuk.org/data-protection. I understand that I can withdraw consent to process my personal data at any time by contacting the Organisers and/or Motorsport UK but that this may affect my ability to act as an Official.

MEDICAL PRACTITIONERS. All doctors attending Motorsport UK Events as medical officers must be fully registered with the General Medical Council, must be members of a recognised medical defence organisation and be covered for work outside a hospital. Doctors must be competent in the field in which they are working and must be aware that they are expected to provide themselves with such equipment as they deem necessary for the proper performance of their duties (G15.1).

Auto-Cycle Union Declaration - Motorcycle event,
Organising Club - National Hillclimb Association.
Permit Numbers - tba Event Name - Wiscombe 500 Owners Assoc. Hillclimb 11th May 2024.

• I agree to act as an official of this meeting in whatever capacity is requested of me by the organisers and I will inform the organisers immediately should I be asked to officiate in a position which I do not feel confident to fulfil for any reason.
• I will inform the organisers 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 carry out my duties.
• In so far as my duties require it, I have familiarised myself with the course/track/circuit and the facilities thereof and declare my acceptance for the purpose of my duties.
• I have read and understood The Auto Cycle Union Ltd Data Protection Policy and I consent to the collection and retention of my personal information by the ACU.
• In so far as my duties require it, I have had the opportunity to read and understand the National Sporting Code of the ACU, the Standing Regulations and such Supplementary Regulations as have or may be issued for the event, and agree to be bound by them.
• I shall not seek to claim against the ACU (other than covered under the Personal Accident Policy), the organisers nor their officials, the landowners, the promoter or other bodies or individuals connected with the event in respect of any damage to my property howsoever caused, whether by the negligence or breach of statutory duty of the said bodies or persons.
Acknowledgement of the risks of motorsport
I hereby acknowledge that as an official I may be exposed to the risks inherent in motorsport and I will undertake my duties with due and proper regard for my own safety. I have read the above and acknowledge that my participation in motorsport is entirely at my own risk.

Declarations

Name*

First Last

Motorsport UK ID Number

Email*

Mobile Number*

Representing (e.g. Motor Club)*

Signature*

By ticking this box, you confirm that you have read and agree to all the requirements listed in this form, for both the Car (Motorsport UK) and Motorcycle (ACU) events.

I agree

Date

Officials Role

Officials' Role, post number if known

Emergency Contact*

Name

First Last

Postcode*

Telephone number*