Hillclimb Marshals
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Person to be advised in case of accident - name and telephone
MOTORSPORT UK PERMIT NO 119622 UNDERTAKING: ALL PERSONS APPOINTED TO ACT IN AN OFFICIAL CAPACITY AT THE MEETING MUST SIGN BELOW. Written agreement of a parent or guardian must also be obtained in respect of Officials under 18 years of age.I agree to act in official capacity at this meeting and in consideration of this the organising club(s) have effected for my benefit a Personal Accident Insurance Policy for death or benefits as prescribed more specifically by Motorsport UK. I have been given an opportunity to read the General Regulations of Motorsport UK and, if any, the Supplementary Regulations for this event and agree to be bound by them. I declare that I am physically and mentally fit to carry out my duties and that I will inform the organisers immediately should any change in my condition occur which I have reason or ought to have reason to believe would affect my ability to carry out my duties. I acknowledge that I understand the nature and type of competition and that as an official, I may be exposed to the potential risk inherent in motor sport and I will undertake my duties with their associated risks with due and proper regard for my safety and that of others. Further, I understand that all persons having any connection with the promotion and/or organisation and/or conduct of the event are insured against loss or injury caused through negligence. Ideclare that I am not suffering from any infirmity or physical disability likely to affect the performance of my duties as an official of the event.I am not currently experiencing any symptoms of COVID-19 and have not done so for 10 days. I have not knowingly been in contact with anyone showing symptoms within the last 10 days, except as a healthcare professional. If after submitting this form I do knowingly come into contact (except as a healthcare professional) with someone with COVID-19 or if I start to exhibit any of the signs indicating that I may be infected I will immediately withdraw from the event, notify Motorsport UK and ensure that my close contacts also do not attend. Should I become ill at or start to exhibit COVID-19 symptoms at the event I shall withdraw safely and notify the Secretary of the Meeting by telephone / SMS accordingly including identification of those others who I have come into contact with at the event. In addition, I confirm that the symptomatic person will as soon as practicable contact the NHS for the purposes of test and trace.I agree to abide by all Government and Motorsport UK requirements imposed in respect of COVID-19. I understand that Motorsport UK Guidance on COVID-19 in relation to Events has Regulatory status and to the extent applicable shall supersede the General Regulations by virtue of GR A.2.4. Breach of this obligation may lead to disciplinary action being taken (C.1.1).I understand and agree that my personal data is being processed solely for the purposes of running this Event and may be used for the purposes of COVID-19 infection tracing, and will be handled by the organisers in accordance with Motorsport UK data protection policy: www.motorsportuk.org/data-protection. I hereby agree to abide by all applicable Motorsport UK Policies and Guidelines including but not exclusively Safeguarding and Anti Alcohol and Drugs policies.MEDICAL PRACTITIONERS. All doctors attending motor sport meetings as medical officers must be fully registered with the General Medical Council, must be members of a recognised medical defence organisation and be covered for work outside a hospital. Doctors must be competent in the field in which they are working and must be aware that they are expected to provide themselves with such equipment as they deem necessary for the proper performance of their duties (G15.1)
VENUE LICENCE 142h ACU DECLARATION: I declare that: - I agree to act as an official of this meeting in whatever capacity is requested of me by the organisers and I will inform the organisers immediatelyshould I be asked to officiate in a position which I do not feel confident to fulfil for any reason. I will inform the organisers immediately should any change in my condition occur which I have reason to or ought to have reason to believe wouldaffect my ability to carry out my duties. In so far as my duties require it, I have familiarised myself with the course/track/circuit and the facilities thereof and declare my acceptance for thepurpose of my duties. I have read and understood The Auto Cycle Union Ltd Data Protection Policy and I consent to the collection and retention of my personalinformation by the ACU. In so far as my duties require it, I have had the opportunity to read and understand the National Sporting Code of the ACU, the StandingRegulations and such Supplementary Regulations as have or may be issued for the event, and agree to be bound by them. I shall not seek to claim against the ACU (other than covered under the Personal Accident Policy), the organisers nor their officials, the landowners,the promoter or other bodies or individuals connected with the event in respect of any damage to my property howsoever caused, whether by thenegligence or breach of statutory duty of the said bodies or persons.Covid-19 I acknowledge the Organisers are operating this event in accordance with Government guidelines, advice and instruction so as to minimise the riskto Competitors, Marshals and Officials and the public from Covid-19. By participating in this event, I will take all necessary steps to protect myself and others from the risk of infection. I agree to follow and abide by anyinstructions set down by the Organiser in an effort to minimise the risk of the Covid-19 virus. I acknowledge and accept the underlying and unavoidable risk of infection from the Covid-19 virus.Acknowledgement of the risks of motorsportI hereby acknowledge that as an official I may be exposed to the risks inherent in motorsport and I will undertake my duties with due and proper regardfor my own safety. I have read the above and acknowledge that my participation in motorsport is entirely at my own risk.
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