Full Name (required)

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Are you a?
ParticipantGuest
If Guest please enter Participants Name

Date Attending?

Address

Street Address

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City

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Your Eircode

Have you visited any countries outside Ireland excluding Northern Ireland?
YesNo

Are you suffering any flu-like symptoms now or in the last 14 days e.g. cough, fever, sore throat, runny nose?
YesNo

Are you experiencing any difficulty in breathing or shortness of breath?
YesNo

Are you experience any fever/temperature symptoms?
YesNo

Did you consult a Doctor or other medical practitioner?
YesNo

Have you been advised by a doctor to self-isolate at this time?
YesNo

Have you been advised by a doctor to cocoon at this time?
YesNo

Have you been in contact with someone who is confirmed to COVID-19 or has visited an affected region in the past 14 days?
YesNo

How are you feeling health wise?
WellUnwell

If you have answered YES to any of the above. Please do not attend your appointment.

If after submitting this form I do 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 and ensure that my close contacts do not attend.
I Agree

Should I become ill at or start to exhibit COVID_19 at the event I shall withdraw safely and notify the organiser by telephone/SMS accordingly including identification of those others who I have come into contact with at the event.
I agree

Have you been to RSI before?
YesNo

Are you happy to receive updates from Rally School Ireland in the Future?
YesNo

In consideration of the confirmation of my booking and the provision of facilities and services by Rally School Ireland (hereinafter called ‘the School’) I hereby agree and declare as follows:

A. I acknowledge that I understand the nature and type of the event and the potential risk inherent with motor sport and agree to accept that risk. I understand that motor sport can be dangerous and accidents causing death, injury, disability, and property damage can and do happen. I understand that these risks may give rise to my suffering personal injury or other loss and I acknowledge and accept these risks.

B. I am in good health, my eyesight is of driving test standard, and I am not suffering from any ailment, disability or complaint as would make it unsafe for me to take in driving or in any of the schools activities.

C. I accept that I am solely responsible for any decision as to my fitness to take part in any driving or any other activity of the school.

D. I accept that I shall be solely responsible for any decision to drive any motor vehicle or use any equipment whilst it is under my control and if I am dissatisfied prior to driving any vehicle or using any equipment I am to discontinue driving the vehicle or using the equipment forthwith.

E. I will save harmless and keep indemnified the school and all of its staff, officers, agents, and any person acting on its behalf, the drivers of the vehicles and any other person or organisation using the facilities in respect of loss of life, injury, harm, loss or damage to me or to my property in the course or as a result of these activities howsoever caused even if the same is caused or contributed to by reason of the negligence or breach of duty on any part of the school, its staff, officers, agents or representatives or such other person or organisation.

F. This wavier has been drawn to my attention by a representative of the school and I understand its terms as a waiver of legal rights and I have given my consent to this waiver freely and willingly in consideration of my being permitted to avail of the facilities of the school.

I hereby declare that the information provided is true and correct to the best of my knowledge.

I agree

By using this form, you agree with the storage and handling of data by this website.
I agree