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Do you suffer from epilepsy, sudden attacks of disabling giddiness or fainting?
Are you without either hand or foot or suffering from any defect in movement or control of muscular power in either arm or leg?
Are you suffering from any disease, mental or physical, or disability which is likely to cause you to be a source of danger to yourself or to the others on the track or on any stadium property
Have you ever suffered a neck injury in the last 5 years?
Can you read at a distance of 25 yards in good daylight, (with glasses if worn) a car registration plate containing up to 7 digits?
Are you colour blind?

I declare to the best of my knowledge and belief that the above answers are true.

I understand that it is an offence for a licensed driver to appear in a meeting on a track not recognised by the promotion.

I further understand that if a licence is granted it is obligatory to study and understand the Buxton Raceway Current Rules, and that no legal action can be taken against the promotion or its officials on any decision or any matter connected with car racing under the regulations of the promotion.

I understand that the completion of this form contracts me to the promotion.

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TO BE COMPLETED BY PARENT/GAURDIAN OF APPLICANTS OVER 10 BUT UNDER 18 YEARS OF AGE

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