Eagles Canyon Racer Development and Licensing School Application

Eagles Canyon Racer Development & Licensing School
Requirements:

1) Solo Certified Driver – No novices. This school needs the driver to be competent in an HPDE environment

2) All Safety equipment required for racing Sanctioning bodies
1. Helmet, Fire Suit, Shoes, Gloves, Current Hans Device,
2. Track prepared race car with current log book, All safety devices up to date and installed properly - Belts, Seat, Fire Suppression
3. Pre-register/apply for a license with any one of the following racing sanctioning bodies – SCCA, NASA, PCA, CVAR
  
  - All pre-registration/License application is required in order to be signed off for a provisional license by the sanctioning body steward at the end of the program. This includes all comleted medical, membership etc.
Cost - In your car: 3 day school = $1950

Registration closes Tuesday morning at 10:00 AM the week prior to the event
Full Name*

First NameLast Name
Select school event
Phone Number*
Birth Date*

MonthDayYear
E-mail*
Street Address*
Street Address Line 2
City*
State (I.E. TX)*
Zip Code*
Country*
Driving Information
DL State*
DL Number*
DRIVING EXPERIENCE (Pro Schools / Competition License / Track Experience / Instruction)*
Vehicle for track day:
Car Class:
Car Number:
How did you find out about us?

Previously AttendedFriend / FamilySocial MediaE-mailECR MemberOther
Emergency Contact - Medical
Emergency Contact Name*

First NameLast Name
EC Phone Number*
Please enter a valid phone number.
EC Email*
example@example.com
Relationship*
Warning:

Motorsports activities can be dangerous. These activities can result in injury or even death. By submitting this form you signify that you understand and assume these risks. Members and their guests will be required to sign waivers to indemnify Eagles Canyon Raceway, all of its employees, and all other participants related to Eagles Canyon Raceway.
Additional Comments
Any relevant Medical Conditions we should be aware of? Anything we can do to help make your track day better?
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