KSQMRC Driver Experience

Saturday November 7^, 2009 – Begins at 11:00 AM

Located behind the Schnecksville Fire Co.

Driver Experience Information

A few very important details:

1. The driver experience is open to children ages 5 to 15.

2. A parent or legal guardian MUST be present for the child to participate in the driver experience.

3. Following safety instruction, each participant will have the opportunity to drive ten (10) laps on the dirt track.

4. The driver must wear jeans, long socks above the ankle, and sneakers.

5. This form must be completed. K & K insurance forms must be signed at the track.

6. KSQMRC, QMA, or any of the members do NOT accept liability for the driver during the driver experience. Participants race at their own risk.

7. A copy of the participant’s birth certificate must be submitted with this form.

Child will not be allowed to race without a copy of birth certificate.

8. The $20.00 entry fee must be paid with this form. Please make checks payable to KSQMRC.

9. Only in the event of inclement weather will event be cancelled.

10. Please be patient with us. Only one car is permitted on the track at a time to comply with club rules and insurance restrictions.

Participant Information:

Name:________________________________________________

Date of Birth:__________________________________________

Participant’s Parent/Guardian Information:

Name(s):______________________________________________

Address:_______________________________________

______________________________________________

Phone:_________________________________________

Email Address:___________________________________

_______________________________ ____________________________

Parent/Guardian Signature and Date Parent/Guardian Signature and Date

**The above signatures verify that the information listed on the form is accurate. The signatures release the club, KSQMRC, & members of liability.