Mid America Challenge Technical Inspection Form

DRIVER-1_____________________________________________ CAR #__________

CAR MODEL____________________________YR___________CLASS_____________

 

INTRUCTIONS

Prior to bringing your car to the track, inspect each item on the car as noted on this sheet. Consult a tech inspector if there is any questions. Making sure your car is ready is your responsibility.

WHEELS

PASS

FAIL

Comments
CONDITION OF TIRES      
ALL LUG NUTS TIGHT AND PRESENT      
NO HUB CAPS OR BEAUTY RINGS      
       
STEERING AND SUSPENSION      
WHEEL BEARINGS FRONT AND BACK      
STEERING PLAY      
STEERING WHEEL LOCK      
       
BRAKES      
PEDAL PRESSURE      
FLUID LEVEL/LAST TIME REPLACED?      
CONDITION OF LINES
BRAKE LIGHTS      
       
ENGINE      
CHECK FOR FLUID LEAKS OIL, WATER, FUEL      
RADIATOR OVERFLOW      
OVERFLOW CONTAINERS      
BATTERY SECURED      
BATTERY TERMINALS COVERED      
NO COOLANT PRESENT      
FLUID LINES      
       
SAFETY EQUIPMENT      
ROLL BARS IN CONVERTIBLES/COBRAS      
SAFETY HARNESS      
HELMET SA 90 OR NEWER      
DRIVING SUIT - REQUIRED      
FIRE EXTINGUISHER      
       
MISCELLANEOUS      
GAS CAP SECURED      
NO WIRES EXPOSED      
VIDEO MOUNT SECURE      
HOT LAP TIMERS SECURE      

 

I have inspected the above vehicle and I take full responsibility for its condition on the track

SIGNATURE OF OWNER/DRIVER ___________________________________DATE_______

EACH DRIVER OF A CAR ENTERED WITH MULTIPLE DRIVERS MUST COMPLETE THIS FORM

VIOLATIONS IF ANY:

 

 

PLEASE READ AND SIGN

THIS AGGREEMENT RELEASES US FROM ALL LIABILITY

I AM AWARE THAT MY PRESENCE AT THE TRACK WHETHER INVOLVED IN PIT CREW ACTIVITIES, SPECTATING, DRIVING AN AUTOMOBILE OR RIDING IN AN AUTOMOBILE ON A RACE TRACK, OR TEMPORARY CIRCUIT DESIGNED FOR, AND USED AS A ROAD COURSE, WHETHER IN A RACE, TIME TRIAL, DRIVER EDUCATION PROGRAM, FOR PRACTICE, TESTING OR OTHERWISE, IS A HAZAROUS ACTIVITY INVOLVING A HIGH DEGREE OF RISK OF SEROUIS INJURY OR DEATH. I AM VOLUNTARILY PARTICIPATING IN SUCH ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED AND HEREBY AGREE TO ASSUME ANY AND ALL RISKS OF INJURY OR DEATH RESULTING FROM THIS ACTIVITY.

I hereby release Mile Hi Cobra Club, NASA (National Auto Sport Association), their officers, members, workers, sponsors of the event, participants, instructors, car owners, any of the officials thereof, and all other persons (hereinafter "RELEASEES"), FROM ANY AND ALL LIABILITY TO ME OR TO MY PERSONAL REPRESENTATIVES, HEIRS, NEXT OF KIN, AND ASSIGNS, FOR ANY AND ALL LOSS OR DAMAGE ON ACCOUNT OF ANY INJURY TO PERSON OR PROPERTY OR RESULTING IN MY DEATH ARISING OUT OF OR RELEATED IN ANY WAY FROM MY PRESENCE AT THE ACTIVITY.

This GENERAL RELEASE expressly releases RELEASEES, from injuries and damages which are caused by negligence (whether active or passive, ordinary or gross), or otherwise. By signing this form I am agreeing to be a participant at this event.

I further agree to indemnify and hold harmless RELEASEES from any and all claims, demands, or liability in breach or violation of the terms of this release.

This RELEASE is intended to be as broad and inclusive as permitted under Colorado/Kansas law. If any portion or provisions of this RELEASE ARE HELD INVALID, IT IS AGREED THAT THE BALANCE OF THE RELEASE SHALL CONTINUE IN FORCE AND EFFECT.

I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND SIGN IT AT MY OWN FREE WILL.

 

_____________________________________ _____________________

SIGNATURE DATE

 

____________________________________

PRINT NAME

 

 

 

PLEASE BRING THIS FORM SIGNED TO THE TRACK. YOU WILL NOT BE ALLOWED ON THE TRACK WITHOUT IT. FOR CARS ENTERED WITH MULTIPLE DRIVERS, THIS FORM MUST BE COMPLETED BY EACH DRIVER.

REGISTRATION DEADLINE _______, 2002