2019 Skid Pan Day Form

Part 1 – Personal Details.  Please complete all fields

Part 2 - Emergency Contact.  Please complete all fields

Part 3 – Vehicle Details.  Please complete all fields.  Vehicles must be road registered

Part 4 - Fifth Gear Motoring terms & conditions

  1. Fifth Gear Motoring reserves the rights at any stage and without compensation or refund of any fee paid by me, to forthwith in its absolute remove me from any course.
  2. I understand that participating in Fifth Gear Motoring programs carries a degree of risk to the person and property. Knowing the risk I still intend to participate and hereby expressively agree to assume the risk of injury and damage while driving.
  3. I shall at all times whilst undertaking said driving course to be subject to the directions of the servants and agents of Fifth Gear Motoring in all respects.
  4. I acknowledge and declare that the motor vehicle supplied by myself to be used on the said driving course is in safe and roadworthy condition and is road registered, having regard to the course and speed which will be produced and that Fifth Gear Motoring shall be under any obligation to scrutineer or examine the same at any time, notwithstanding Fifth Gear Motoring shall be entitled to do so at their discretion.
  5. I declare and confirm that I am physically fit and have no conditions or injuries that could be affected by my participation in the said course. I acknowledge that it is a fundamental condition of my participation in the said course that I have notified Fifth Gear Motoring and or its servants of any existing medical condition which may affect my participation in the said course and which may exacerbate or deteriorate as a result of injury sustained during the said course.
  6. I am not taking any medication that would impair my faculties or otherwise affect my ability to safely control a motor vehicle.
  7. I hereby consent to receive medical treatment that may be deemed necessary by Fifth Gear Motoring and or its servants in the case of injury, accident or illness in the course of undertaking a Fifth Gear Motoring course and agree to indemnify Fifth Gear Motoring in respect of such medical treatment.
  8. I have a current drivers licence, the details of which are correctly recorded below.
  9. I do hereby for each of our heirs, executors and administrators release Fifth Gear Motoring and all their officials, employees, representatives or agents collectively and individually from all actions, suits, claims and demands for any loss, damage, injury or cost incurred or sustained or made by me arising directly or indirectly out of my participation in any capacity in a Fifth Gear Motoring course and furthermore I agree to indemnify Fifth Gear Motoring and their servants, representatives and agents from and against all actions, suits, claims and demands or other liability in respect of death or injury to any person including myself and the loss or damage to the property of any person, company or organization including myself however arising out of, or in conjunction with my participation in a Fifth Gear Motoring course and notwithstanding that the same may have been contributed to or caused by the negligence or fault of Fifth Gear Motoring or their officials, servants, representatives or agents.
  10. I give consent for any photos taken during this course to be used for Fifth Gear Motoring promotional use.

Fifth Gear Motorsports conditions of participation.

  • The vehicle you provide is within legal street noise limit - 90dBA per ACT standards AND is below 85 dBA from 30 metres at all times. THIS is 100% compulsory!
  • I understand and can confirm the vehicle which I am using to participate is road registered and roadworthy.
  • You may only park your car in designated parking areas or as directed by FGM staff.
  • You must not walk on or within 5 metres of the training skid pan.
  • There is to be NO passengers in vehicles when conducting training unless otherwise directed by FGM staff
  • There is to be NO overtaking on the skid pan, you must stop if there is a car stationary on the skidpan and not overtake.
  • There is to be NO burnouts or excessive wheel spin on the skid pan.
  • Seatbelts must be worn at all times during training
  • Limbs are to be with the vehicle at all time during training
  • No animals or alcohol are permitted on the training complex
  • Children under the age of 15 are not to be left unsupervised at any time.
  • By agreeing to these terms you may be held liable for costs if property is damaged by you.