Drag Race School Entry Applicat

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Drag Race School - Client Application Form
Safety and Control

Name _____________________________________

Address ___________________________________

City, State, Post Code _________________________________________

Home phone number __________________ Work Phone number __________________

Mobile phone number __________________ Fax number _______________________

Birth date ____________________ Height _________ Weight _________

Physical condition __________________________________________

When did you see your first drag race at a race track ? ______________

How many times have you been to a drag race ? __________________

Have you ever "lit the top bulb" on the tree ? __________ When ? ______________

What type of car ? ___________________________________________

How quick did you run ? _______________________________________

Have you ever crewed on a drag race car ? _______ Type ? ___________

If you get your license would you like to compete with your own car ? Y N

If you won the lottery what type of car would you race ? _______________

Would you make a career of driving a race car ? __________

Do you want to have your ANDRA license application endorsed Y N

Have you taken your ANDRA required physical examination ? _________

Have you applied for your ANDRA provisional license ? _________

Have you received it ? _______________

Please add any information that can assist us in your attendance at the Drag Race School

___________________________________________________________________________________

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PLEASE TICK ONE BOX

5 I want the group package 5 I want the 1 on 1 package

To attend the Drag Race School you must be a road licensed driver. Please include a photo copy of your driver�s license with this application.

Credit card number _______-_______-________-_________ Expiry __________

Name on credit card __________________________________

There is a printed number on the back of your credit card on the signature line.

Would you give us the last three digits of that number. __________

I agree to participate in the Drag Race School and agree to the terms of the liability waiver and approve the credit card charges for this program.

Name (print) ______________________________

Signature __________________________ Date __________________

You will be required to sign the Liability Waver / Agreement below before participating in the DRS program.
Please fill out this form and mail or fax or email it to ken@kenlowe.com.au
If not paying by credit card you can make a deposit of $995.00 by check the check must be made out to Ken Lowe and included with this application. The balance must be paid in full at least 30 days prior to participating at the DRS.

1. Print out this page. (Ctrl+p)

2. Please fill out the form completely and return it to the Drag Race School.

3. If you don't have a credit card please include your deposit with this form.

Drag Race School
P.O. Box 180 Rosewood QLD 4340

Phone: 0411-699-535

Your pre school info packet will arrive in the mail to you.
- Confirmation letter
- Drag Race School itinerary
- Good driving rules
- Dress for success
- Guest policy
- Simplified starting line procedures
- Brake with your left foot
- Introduction to the race car
(familiarization photos with instructions)

If you have any questions about our Drag Race School please
feel free to ask at any time or write your query down below.

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Liability Waver / Agreement

050816 (1) - (30)

1. I wish to participate in the two day training school conducted by you on the conditions set out in this agreement.

2. I am aware that drag racing, observing drag racing, learning to drag race and training to drag race are dangerous activities and in undertaking such activities I do so at my own risk.

3. I am aware that it is a condition of participating in the two day school that you, your directors, instructors, members, servants and agents are absolved from all liability howsoever arising from injury or damage howsoever caused (whether fatal or otherwise) arising out of my participation in the training school or drag racing, observing drag racing, learning to drag race or training to drag race or in any way whatsoever due to any negligent act, breach of duty, default and/or omission on the part of you, your directors, instructors, members, servants or agents.

4. I am also aware that any person drag racing, observing drag racing, learning to drag race, training to drag race or in connection with drag racing or participating in any activity carried out by you are only allowed to do so on the distinct undertaking that they do so at their own risk.

5. I hereby acknowledge that of my own free will and desire I have contracted with you for instruction and training in drag racing activities and that I have read and understood the warning above.

6. I acknowledge that it may be necessary for you to postpone a particular training course, or part thereof for reasons beyond your control, including, but without limitation, bad weather, mechanical repairs, illness, etc. I accept that you may, in your absolute discretion, postpone any particular training school to a later date and I will participate in such later school on the same conditions as contained in this agreement. Any monies that I have paid for the initial course will be treated as payment towards the postponed course.

7. I hereby acknowledge and agree to follow all the instructor�s direction and instructions. I also agree that failing to follow those instructions the instructor has full and final authority to terminate my training program, at any point, without any financial refund.

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Signature Witness

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Name Date

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Address