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CWMDU

 AUTOGRASS CLUB (C)

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The Ovals, Lyonshall, Kington, Herefordshire, HR5 3LN

CWMDU

ARE NOT TAKING ONLINE APPLICATIONS AT THIS TIME. PLEASE CONTACT YOUR CLUB SECRETARY
 

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NATIONAL AUTOGRASS SPORT ASSOCIATION LTD.

LICENCE APPLICATION FORM

(CWMDU)

By completing this form you are giving consent to Cwmdu Autograss Club to apply on your behalf for the issue of a NASA licence in the category you select below.

Please complete all details for the applicant (intended licence holders) and tick the "terms and conditions" box . Ensuring that you provide your signature on this application.

In addition, please tick the "medical declaration" ONLY if this applies to you. 

APPLICANT DETAILS (INTENDED LICENCE HOLDER)

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LICENCE INFORMATION

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CAR INFORMATION AND RACE NUMBER

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I have read, understood and agree to abide by the rules covering Autograss Racing as issued by the National Autograss Sport Association Ltd. (NASA) I further agree to save harmless and keep indemnified the Club, N.A.S.A. and the respective officials, members, landowners, servants, representatives and agents and / or drivers and mechanics from all actions, claims, costs, expenses, and demands in respect of loss, death or injury to myself, howsoever caused, notwithstanding that the same may have contributed to, or occasioned by, the negligence of several persons or bodies otherwise than in connection with the business or activities of the Club or NASA Ltd., and further to keep indemnified the said parties in respect of death, injury, or loss sustained by any third party as a result of the member negligence and / or breach of contract, save in so far as in either event the said liability is covered by a policy of insurance. I further realise that I shall take part in the sport of Autograss Racing entirely at my own risk.

Please tick this box if you have a medical condition or disability such as epilepsy, are without ar,s/legs/hands, mental or physical incapacity or failure to read a UK registration plate from 25 yards or are colour blind, and supply a suitable doctor's letter confirming that you may safely participate in Autograss Racing.

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Please sign to state you  agree to share your information with National Autograss Sport Association Ltd.

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SUBMITTING YOUR APPLICATION WILL TAKE YOU TO THE PAYMENT SCREEN

(PLEASE DO NOT REFRESH YOUR SCREEN)

Please follow the process below to apply for a National Autograss Licence and become a member of Cwmdu Autograss Club. This process if for new and existing Cwmdu  membership.

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If you have any club queries please contact Kelly Murray Registration Secretary by email kellymurray77@hotmail.co.uk or call  07734 559375

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PARENT GUARDIAN DECLARATION.

Only the child's parent may sign this form, or such person who has been appointed by the court as guardian or foster parent of the child.

Please read the terms of this consent carefully, if you do not understand anything then ask your local Club Secretary for clarification. It is designed to create a legal relationship between you and ourselves and, by signing the document where required, you confirm that you have read this document and agree to abide by its terms and conditions and requirements.

Autograss Racing is a sport that minors may participate in with their parents' consent. It is not organised primarily for minors but their involvement is encouraged providing they and their parents understand the hazards that are associated with the sport. Motor racing is dangerous and may involve the risk of injury or death.

1. You should read and understand the current issue of the Members Handbook before signing this form. This is available in hard copy from your club secretary.
2. You, the signatory to this document, are ultimately responsible for your child at all times whether you are present at the NASA meeting with them or not and by signing this form you confirm that your child is physically fit and competent to take part in the type of events for which you are allowing him or her to participate.
3. If you do not attend any NASA meeting with your child you must arrange for a NASA Licence holding adult (over 18) who holds a Full or Mechanic's Licence to take charge of your child throughout your child's period of attendance at that meeting – including night time where applicable. You will agree that responsibility with that adult beforehand and your child is to clearly understand who their guardian is throughout the period.
4. If and when asked by a NASA official, your child will tell the official who their guardian is on the day. Failure to have a guardian present will result in your child taking no further part in the event and you being contacted and asked to remove the child.
5. You, as next of kin and person responsible will provide your name and address at the time of