Indemnity Form

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Northern Farms Nature Reserve – Access From R114 – Diepsloot – Johannesburg
Dave White: 083 226 9416
Po Box 4839 – Halfway House 1685 - www.terratopia.co.za – info@terratopia.co.za
Rob Bowen: 083 401 5319
2016 - ANNUAL INDEMNITY / DISCLAIMER - CLUB MEMBERS - 2016
WARNING – YOU ARE PRESENT AT YOUR OWN RISK – TERRA TOPIA DIRT BIKE CLUB CANNOT GUARANTEEE YOUR SAFETY – PLEASE BE CAREFUL
Motorsport is dangerous. In view of the high speeds attained by the participants/competitors, accidents can/may happen. The land owners/promoters/organizers of this facility/event/competition cannot guarantee
your safety. I/we fully understand that I/we are participating in an activity entirely at our own risk and that I/We are fully aware that two-way traffic, hazardous terrain and the high speeds obtained by
vehicles/motorcycles and other unforeseen dangers shall be encountered at any time whilst being a spectator or riding/participating in any activity where potentially dangerous situations for serious or even fatal
accidents for riders, participants and spectators alike may be created.
NAME: ___________________________________ SURNAME: ______________________________________ ID NUMBER: ________________________
EMAIL: _______________________________________________ CELL NO: _______________________________ CLUB MEMBERSHIP NO: _________
EMERGENCY TEL NO: ________________________________________
MAKE OF BIKE: ____________________________ BIKE NO: ___________
Riding Fees: There are two fees applicable - Big wheel Snrs & small wheel Jnrs on the big Snr track - 65cc on the Jnr novice track need only pay the lesser fee.
Wednesdays – Snrs R180 ( 21” front wheel) / Jnrs R140 / Novice R100 p/rider
Weekends / Public Holidays Snrs R200 ( 21” front wheel) / Jnrs R160 / Novice R120 p/rider
All rider fees now include a mandatory additional R10 Nature Park Levy
All Non-Member Riders To Pay An Additional R30 practice premium.
Additional Spectators/Passengers - Housekeeping Fee: Practice Days - R10 p/person - Race Days – R50 p/person
All competitors are allowed only one mechanic / driver / family member / passenger / visitor to enter for free per entry on all Fun Days and championship race days.
On Wednesdays neither track will be watered totally unless there’s sufficient rider numbers. This is to limit wasting water. Corners & other areas may be watered as considered appropriate on the
day by the attendant. The fee may be adjusted accordingly so that it is fair to everyone. The attendant’s decision will be considered fair & final.
PLEASE NOTE: The track will be closed for preparation during the week except for every Wednesday which offers a prepped track with watered corners & dust suppression. In extreme cases, machinery & workers may be on the track
during operating times – the risk is & remains totally your own. The track may be closed for the entire week preceding formal sanctioned “championship” race events. This restriction excludes Fun & Club Race Days. Please call first or
view the website for race dates & the regulations. The signatory hereby also agrees to receive all club notices, circulars & promotions etc via e-mails, sms, or any other form of social media communication.
(Our TT Fun Day events include a fully race prepared track, extra watering, medics on standby, music, food & beverages. Fun trophies & surprise promotional gifts from sponsors when available.)
IMPORTANT – GENERAL RULES / WARNINGS / TERMS AND CONDITIONS
Helmets must be worn at all times while operating a motorcycle. All motorcycles & vehicles to be operated a “walking speed” in the pits. This will avoid accidents & reduce dust.
KEEP BIKES & VEHICLES OFF RESTRICTED AREAS. Operating a motorcycle outside demarcated boundaries/routes is STRICTLY forbidden. Please respect this request in order to protect & secure our future right to ride.
BY ENTERING THE PROPERTY I/WE ACKNOWLEDGE THAT I/WE ARE PRESENT AT MY/OUR OWN RISK. I/WE FURTHER DECLARE THAT I/WE AM/ARE AWARE OF THE RISKS, DANGERS &
PERILS ASSOCIATED WITH ANY FORM OF MOTORISED SPORT AND OTHER EXTREME / ADVENTURE ACTIVITIES THAT I/WE MAY PARTICIPATE IN.
I/we, the signatory to this document, do hereby state and agree that I/we are aware that driving/riding or racing any vehicle and the use of any equipment has certain inherent dangers. Accordingly I/we (in my
personal capacity and as agent for and on behalf of my dependents and passengers whom I warrant, have duly authorized me to participate in any activity and to sign on their behalf), hereby indemnify and hold
harmless and free of liability, TERRA TOPIA DIRT BIKE CLUB, KILLER STYLE PROMOTIONS, NORTHERN FARMS NATURE RESERVE, CITY OF JOHANNESBURG, JOHANNESBURG WATER (PTY) LTD, Majuba Technologies Pty
Ltd, MSA, WOMZA or any of their associates, promoters, agents, companies, private persons, all members, owners, directors, employees, assistants, race officials, sponsors, representatives, management, employees,
assistants and/or also the OWNERS OF THE PROPERTY known as Northern Farm Nature Reserve, situated off the R114 in Diepsloot – (All are hereinafter referred to as “The Entities”). Similarly, I/we hereby indemnify
and hold harmless and free of liability all “The Entities” for any activity or whilst participating, being a spectator or attending/visiting, whether under supervision or non-supervised. I also absolve or hold free of any
legal liability “The Entities” offering their services from any injury – fatal or otherwise – sustained by myself/ourselves/spouse/family members/friends or persons in my/our care or from any loss or damage to property
in my/our possession or any loss of whatever kind that may be sustained during my competition/activity taking place on the property or any practice run or leisure ride and even though that same may be contributed
to or be caused by the willful act, neglect or default of any official, agent, servant or representative of “The Entities”. Insofar as I/we, at any time make use of or drive any vehicle, motorcycle, kart or quad, of which
I/we are not the owner, I/we warrant that I/we have the owners’ permission to make use of/drive/ride such motorized vehicle, motorcycle whilst attending any event, fun day and leisure ride and am/are therefore
duly authorized on behalf of the owner/s to furnish the indemnities hereby given and shall be personally liable for any incident or claim against me/us as the operator of the motorized machine. I/we further agree that
this assumption of and consent to risk shall also operate against my dependents and/or heirs, executors and administrators.
I/We hereby confirm that I/we are familiar with the general rules of Terra Topia Dirt Bike Club & hereby declare that I/we will conduct myself/ourselves accordingly within the guidelines set to ensure a pleasant
experience for all. I/we are aware of the areas which are prohibited. I/we also acknowledge that if found guilty or reported that any property has been damaged or destroyed as a result of my/our actions, I/we accept
that I/we will be held fully accountable for my/our actions and the consequences that may follow and that I/we will pay for all damages caused by me/us or others I/we may be responsible for. I/we acknowledge that
court action may be taken against me/us singularly or collectively to recover all repair costs, as well as those costs incurred between attorney and client. I/we also understand that any land owner/entity has a right to
protect their property against unauthorized use and may take action to prevent vehicles entering or crossing their property illegally. This action may be of an unknown nature and I/we therefore declare that I/we will
not take any legal action against the land/property owner/s, Terra Topia, or any of “The Entities” or associates for any reason whatsoever if I/we wander off the demarcated/set out route/course. I/we also confirm
that all the land in use shall be treated in an environmentally friendly way & that old oils/fuels and litter will be disposed of in the correct manner and in the designated drums/bins available in the pit area.
DOPING – DRUGS / ALCOHOL USE DURING OR BETWEEN RIDING IS STRICTLY FORBIDDEN
I/we hereby voluntarily and irrevocably give my/our consent to allow any club/organizer appointed and suitably qualified medic to act as the Doping Control/Alcohol Control Officer to examine me/us prior to, during or
following any activity at Terra Topia Dirt Bike Club. Should it deem to be necessary, I/we further agree to allow a sample of my/our blood and/or urine to be taken for laboratory analysis by the appointed Doping
Control/Alcohol Control Officer concerned to determine the presence of alcohol or prohibited drugs as listed in the South African Institute for Drug Free Sport’s (SAIDS) Doping Code. I/we hereby also accept that Terra
Topia management or any of its representatives/associates has the right to suspend/end my/our further participation in any/all potentially dangerous activities with or without proof of my condition at the time and
that I/we will graciously/humbly accept the reason/s for the suspicion & resultant suspension regardless and without seeking retribution/compensation. This is in the interest of safety for all attending persons.
MINOR - RIDERS / PARTICIPANTS - UNDER THE AGE OF 18 YEARS
In my capacity as father/guardian/curator* of the minor, I hereby consent to the participation of my son/daughter/minor/ward* in any form of activity on the property managed by “The Entities” and I agree that this
form of consent can be read as part and parcel of and together with the above mentioned form of indemnity to which I have also agreed to and signed this day. I furthermore acknowledge that I accept that I and my
dependents are bound by the rules as set out by Terra Topia Dirt Bike Club.
*Full Name: ____________________________________________________________ ID No. ____________________________________________ Age: _______
*SIGNATURE __________________________________________________________________ Date: ________/________/ 2016
I/We hereby confirm that I/we have read the terms and conditions set out herein and I/we are fully aware & understand the indemnity/disclaimer, plus the rules of Terra Topia Dirt Bike Club.
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