Clone of Canvastown Rider Registration

CANVASTOWN RIDER REGISTRATION

SELF GUIDED OPEN TRACK
NEW BANK ACCOUNT

The track will be open for your use from 9am - 5pm.
We ask you to respect the landowner his property and all other riders that may be on the track.
CANVASTOWN MX TRACK
OPEN TRACK FACILITY
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SENIOR, JUNIOR $35

MINIS (8 years and under) $25

DONATION FEES ARE TO FUND THE LAND'S LEASE AND MONTHLY TRACK MAINTENANCE.

ALL RIDERS MUST HAVE A CAPABLE SUPPORT / WATCH PERSON WHILST THEY RIDE AS YOU ARE RIDING AT YOUR OWN RISK.

(All riders must be pre-registered to access the Canvastown MX track, ignorance to do so may eventuate to you becoming blacklisted)
Requested Ride Date: (MUST BE CORRECT)

MonthDayYear
Date
Riders Information
Full Name:

First NameLast Name
Birth Date:

DayMonthYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail
Parent/Guardian e-mail if 16 years and under
Rider's Motorcycle
Rider's Race Number
- If you have any additional riders with you, you MUST fill in this section. This is to ensure the landowner is reimbursed correctly with correct rider data.
- Full Name:
  
  First NameLast Name
- Rider's Motorcycle
- Rider's Race Number
- Full Name:
  
  First NameLast Name
- Rider's Motorcycle
- Rider's Race Number

TRACK DONATION:
prevnext( X )
Rider: Over 8
$35.00 NZD Quantity

Rider: 8 & under
$25.00 NZD Quantity

Total

$0.00 NZD
PREPAYMENT ONLY VIA BANK TRANSFER

Please use riders name + date as reference

NEW ACCOUNT NUMBER

*03-1354-0453415-00*

PAYMENT IS DUE AT THE TIME OF REGISTRATION.
TRACK TERMS & CONDITIONS FOR RIDERS

You MUST be aware that motorcycle riding can be dangerous and can cause injury.

1. I am aware that the sport of Motorcycle riding might cause me injury or death and damage my property.

2. Any child under the age of 14 must be supervised at all times with or without a bike by the adult who signed this registration form (Parents or adult supervisors) Children 14-15 need supervision while riding.

3. Neither I, or anyone associated or connected with me, will make any claim against you or your officers, employees or agents in respect of a) any injury suffered by me; or b) any damage to any of my property, regardless of how the injury or damage occurs.

4. I will indemnify you against all claims, damages or losses (including costs) which you incur as the direct or indirect result of any injury to me or damage to my property.

5. I am physically fit, and there is no health or other reason why I should not participate in the sport of Motorcycle Riding.

6. I agree that any bike and equipment I/we will ride or use has been maintained and is in good working order. Check brakes, levers, chain, sprockets, suspension, wheels and helmets.

7. I agree that I will not ride under the influence of alcohol and/or other drugs at this event.

8. I am aware that if I do not obey the Canvastown rules for riders, I could be refused entry at this event and other Parkesville and relating party events.

9. I am aware that this disclaimer will not affect any legal obligations you have to me, which you cannot contract out of under NZ Law.

10. I agree that in this disclaimer, “my property” includes any property owned by me or in my possession or under my control.

11. I agree that this disclaimer will be binding on my family, my heirs, my legal assigns and my administrators and executors.

12. The consent is given in accordance with the Privacy Act 1993.

I understand that no refunds will be given once payment has been received from the registration.

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
I, the rider (or parent/guardian if under 16) Parent/Guardian Name ofRiders Full Name* hereby consent to all the above term and conditions.
Signature
Location -

422 KAIUMA BAY ROAD, CANVASTOWN
Turn off at Daltons Road bridge, right turn onto Kaiuma Bay Road. At the next intersection turn right and continue along kaiuma Bay Road.

Please drive slow and be respectful on the gravel road and grass. This is an operational farm, if you open any gate or drop any strip for access this is to be immediately returned to how you found it.
Should be Empty:

CANVASTOWN RIDER REGISTRATION

TRACK DONATION: