HSCCQ :: Event Entrant Info Declaration

Event Entrant Information Declaration

Held under the International Sporting Code of the FIA and the National Competition Rules of Motorsport Australia.

The event is being run in accordance with the Motorsport Australia COVID-19 guidelines.

Meeting Promoter

Holden Sporting Car Club of Qld, Permit number:

Meeting Location / Date

Willowbank Raceway / 2021-04-18

I have read and understand the Supplementary Regulations

I have read and understand the Drivers Briefing

I have read and understand the HSCCQ COVID-19 Policy Statement

I am the Owner/Competitor for the vehicle I am driving

I have completed the Self-Scrutiny Checklist form and emailed that to entries@hsccq.com

I have completed the Self-Scrutiny Statement of Vehicle Compliance form and emailed that to entries@hsccq.com

If my car is QLD registered, I have obtained a (pdf format) CTP Rally Extension document and emailed that to entries@hsccq.com

Vehicle is Registered in QLD

Vehicle Rego/Nickname

Driver/Entrant Full Name

Driver/Entrant Phone Number

Driver/Entrant Email Address

Motorsport Australia License No.

Full Name of Plus One (single person driver is bringing)

Phone Number of Plus One

I am bringing friends or family as spectators

Spectator 1 - Full Name

Spectator 1 - Phone Number

Spectator 2 - Full Name

Spectator 2 - Phone Number

Spectator 3 - Full Name

Spectator 3 - Phone Number

Spectator 4 - Full Name

Spectator 4 - Phone Number

Have you or any of your spectators been in contact with a person with COVID-19?

(if so you MUST inform us)

If yes, provide details (including dates) of
the COVID-19 contact

I understand this information may be sent to Motorsport Australia and any other COVID-19 body as required

I accept the above details are correct and allow them to be forwarded to the above