Passenger Indemnity: South Island Champs 2018

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Passenger Details

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Next of Kin Details

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Passenger Indemnity Details

I, the undersigned, hereby confirm and warrant and agree to be bound by the following terms and conditions in favor, and for the benefit of, LR (Levels Raceway), 4NR (4 & Rotary Promotions), LR4NR (All Employees of Levels Raceway, 4 and Rotary Promotions):

1. I will comply with the Occupational Safety and Health Regulations provided to me by LR or 4NR at all times.
2. I will at all times comply with the instructions of the LR and 4NR employees and agents.
3. I will exercise all due care and will at all times comply with the Safety Regulations of the Levels Raceway.
4. I understand that the Levels Raceway Circuit Manager or any of their employees or agents may terminate and prohibit my access to the facility if I breach any of the terms in this indemnity form.
5. I will be responsible for and will pay to make good any damage I may cause, whether deliberately or otherwise, to any property of Levels Raceway.
6. I will not hold LR or 4NR responsible for any damage, injury or death caused by mechanical failure or otherwise of any vehicle supplied by those parties, whether directly or through a sub-contractor, or due to the state of the Levels Raceway Circuit.
7. I understand that in consideration of LR granting me permission to use the Levels Raceway Circuit I warrant all of the above and will indemnify LR, 4 and Rotary Promotions and together with their employees, directors, officials, representatives and agents from and against all actions, claims, costs, expenses and demands in respect of death, injury, loss or damage to person or property however caused, arising out of or in connection with my use of a vehicle and the Levels Raceway, including claims by third parties, notwithstanding that such claims may have been contributed to by the fault or negligence of LR, 4 and Rotary Promotions.

By filling out this form, you can now purchase your Passenger Wristband faster on the day for $5 donation which will be donated to charity proceeds. No paperwork will need to be filled out on the day if you've filled out this form.

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