First Name *

Last Name *

ID Number *

Email Address *

Cellphone Number *

Address

Go Kart Number *

Club *
—Please choose an option—Zone 7SwartlandCape Oval DirtGeorgeOudtshoornUnaffiliated – Visitor
Class *
Development200cc270cc Mods300cc Mods390cc StandardLadies 390cc Standard390cc ModsSupermodsOutlaw Karts/WingsBeetlesOpen
I have competed in more than 3 events *
YesNo

Medical Cover
YesNo
Name of Emergency Contact *

Emergency Contact Number *

CLUB MEMBERSHIP
Club Membership Number *

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.

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
Yes

Entry Fee: R 100.00 – Members
                   R 100.00 – 2nd/3rd Family Member
                   R 150.00 – NON Members
                   R 50.00 – Gate Entry Fee pp
                   R 30.00 – Children 6-12 pp

Bank Account Details
Bank: Capitec
Account Name: Zone 7 Dirt Karting
Account Type: Savings
Account Number: 220-396-9918
Branch Code: 470010
Reference: Name and Surname

Please send Proof of Payments to admin@zone7.co.za

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