2026 Harts Range Motokhana Nomination Form

All nominations must be completed and sent in by the Wednesday 29th July 5pm, no late nominations will be taken.

Payment can be made on the day, or before the event to

Harts Range Amateur Race Club

BSB: 085 995 ACC: 560 798 276 or use Pay ID: treasurer.hrarc1@gmail.com

Reference: Motorkhana (Competitors Name)

Please send nominations and payment receipt to noms.hrarc1@gmail.com

RULES:

Intoxicated persons will not be allowed to compete
No Quad bikes- only 2 wheeled motorbikes
Motorbike helmets, long sleeved shirt, long pants and enclosed shoes must be worn
The Officials decision is final
No refunds provided unless the event cancelled
IF MOTORBIKES ARE RIDDEN OUTSIDE THE EVENT TIME & LOCATION BARRIERS, YOUR NOMINATIONS WILL BE SCRATCHED
(& NOT REFUNDED) AND MOTORBIKE CONFISCATED UNTIL THE END OF THE WEEKEND.

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Event	Juvenile 5-8yrs	Junior 9-15yrs	Senior 16yrs+
Barrels	yes	yes	yes
Thread the Needle	yes	yes	yes
Bending	yes	yes	yes
Sack Race	yes	yes	N/A
Bang & Go Back	N/A	yes	yes
Wheel Stand	N/A	N/A	yes
110cc Mini Event (4 stroke Only)	N/A	N/A	yes

Date of Birth

Date

Category

MA License/Insurance

MA License Number

First Name* Last Name*
(In this acknowledgement, "I" refers to myself, "my child" refers to the junior participant on whose behalf I am signing this acknowledgement and declaration, and "Participant" means either myself or my child, as applicable.)
I agree and declare that:
I acknowledge that the Participant takes part in the Harts Range Amateur Race Club Inc. Motorkhana ("the Event") at their own risk.
I further acknowledge that the Harts Range Amateur Race Club Inc., Mt Riddock Pastoral Pty Ltd, the Harts Range Amateur Race Club Inc. members, officials, volunteers, fellow participants and employees are not liable for any personal injury, death, loss or damage suffered by the Participant in connection with the Event, or for any loss of or damage to the Participant's property or possessions, whether such liability arises under any express or implied term relating to participation in the Event, at common law or otherwise.
I agree to immediately report any injury sustained by the Participant to the Event organiser, together with the circumstances in which the injury occurred.
I acknowledge that it is my responsibility to ensure that I and/or my child have appropriate ambulance cover for the Event.
I acknowledge and accept that the Harts Range Amateur Race Club Inc. members, officials and volunteers accept no responsibility for a rider's level of knowledge, skill or experience. Any concerns regarding a Participant's competency should be raised with Event officials at the time of nomination.
I acknowledge that the Committee reserves the right, at its absolute discretion, to refuse any nomination or entry to any Event. The Committee also reserves the right to refuse entry to the Motorkhana area to any person where it considers this necessary for the safe and orderly conduct of the Event.
I hereby consent to the collection of photographs and video recordings of the Participant. I acknowledge that these images may be used on social media, websites, newsletters and other publications. I further acknowledge that the Participant's image may be used by the Harts Range Amateur Race Club Inc. to promote future Motorkhanas.
I understand that I may withdraw this consent at any time by providing written notice to noms.hrarc1@gmail.com.

Signature* Date*

Motorkhana Registration