Junior Self Scrutineering Form:

INDEMNITY & SCRUTINEERING FORM.

*Please note Moms = Manual of Motorcycling Sports. This can be found on the MV website in a downloadable document.
Name*

First NameLast Name
VENUE:*
Date of Event:*

MonthDayYear
CLASS:*
eg: 65cc 7-U10 or MX1 C
MAKE:*
eg: HUSKY
MODEL:*
eg: 250cc
2nd CLASS:
eg: 65cc 7-U10 or MX1 C
MAKE:
eg: HUSKY
MODEL:
eg: 250cc
RACE NUMBER:*
FUEL TYPE:*
Please tick:*

Brakes - front oeprationalBrakes - rear operationalWheels - front spokes tensioned correctly, no movement in wheel bearings, no cracks in rim.Wheels - rear spokes tensioned correctly, no movement in wheel bearings, no cracks in rim.Front plate number complies with MomsLHS plate number complies with MomsRHS plate number complies with MomsHandlebars & Levers - In good condition. Levers meet rquirements listed in the Moms.Kill Switch working correctlyFoot rests - in good condition and not binding on pivotSelf closing throttle operationalExhaust/Silencer/Noise - in good conditio0n and meets sound emissions as listed in the MomsNuts, Bolts & Fasteners - Tensioned correctlyHelmet in good condition and meets standard listed in the MomsBack numbers - Must be legible and number mnatching your bike number.Boots in good conditionGloves & Goggles in good condition
I awknowledge that the onus of presenting a safe machine that is compliant with the manual of motorcycle sport remains my sole responsibility throughout the duration of the event.
NOTE:
1. All riders helmets must be presented at sign on for inspection (and when required have the Eject System fitted).
2. Random scrutineering will be conducted on machines and rider safety gear across all classes throughout the event
3. Incomplete forms will not be accepted.
4. When required both the rider and parent or guardian must sign this form for it to be considered complete.
5. One scrutineering sheet must be completed per machine.
6. By signing this form I acknowledge that I have read, understand and accept the conditions on the Indemnity provided for motorcycle activity
Signed by Parent/ Gaurdian or Rider over 18yrs old.*

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First NameLast Name
Date*

MonthDayYear
(Date of completing form)
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INDEMNITY & SCRUTINEERING FORM.