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SOUTH ISLAND & SOUTHLAND SCHOOLS MOTOCROSS 2017
incorporating Southland Secondary Schools MX
Saturday 7th April 2018 - Permit #17279
Hosted by the Gore & Districts Motorcycle Club @ Dale's Property
809 Mandeville Kingston Crossing Road, Riversdale, Gore
for available classes & full event information .
A seperate entry must be submittted for each competitor.
Once all compulsory fields are completed please select 'SUMBIT' at bottom of form to lodge your entry.
MNZ Licenced riders to enter competitive classes only (exception 8-11 year support class).
Some classes have been combined due to insufficient entries at closing
Competitive 15-19 years 125cc class has been combined with 15-19 years 250cc
Novice 12-14 years 125/250cc, Novice 15-19 years 125cc & Novice 15-19 years 250cc have been combined into one class - Novice 12-16 years 125/250cc
Indicates required field
Class entered (select applicable class from dropdown list)
Competitive 12-16 Years 85cc (60-85cc 2 stroke & 100-150cc 4 stroke)
Competitive 12-14 Years 125/250cc (90-125cc 2 stroke & 151-250cc 4 stroke) * min 14 yrs to ride 250cc 4 stroke
Competitive 12-19 Years Girls MX (max capacity 125cc 2 stroke & 300cc 4 stroke) * min 14 years to ride 250cc 4 stroke
Competitive 15-19 Years 125/250cc MX (151-250cc 4 stroke)
8-11 yrs Support (60-85cc 2 stroke & 100-150cc 4 stroke) * min 9 yrs to ride 150cc 4 stroke
Novice 12-16 years 85cc (60-85cc 2 St & 100-150cc 4 St)
Novice 12-16 years 125/250cc (maximum 200cc 2 St300cc 4 St) * min 14 years to ride 250cc 4 stroke
MNZ Licenced riders not eligible for Support/Novice classes except for 8-11 year class
To be eligible for Year Awards or Team Points you must be entered in a Competitive class & be year 9 or above (attend Secondary School).
Year 8 students may compete in Competitive classes if of correct age but are not eligible for Secondary School Awards or Trophies.
Support/Novice Classes only recognised 1st-3rd in each class as individuals
Team points awarded to the top 3 scoring riders from same Secondary School entered in a Competitive class.
No team entries required. Team trophy for South Island & Southland Secondary School with highest combined 3 scores.
Please refer to S
for full event information
Bike Make & CC (select from dropdown list)
OTHER (Complete details in next section)
Bike Make & CC (If not listed above please complete)
Date of birth
Age on race day
School Name (select from dropdown list)
Aparima High School
Blue Mountain College
Burnside High School
Central Southland College
Christchurch Boys High School
Craighead Dioscesan School
Darfield High School
Geraldine High School
Gore High School
Greymouth High School
James Hargest College
John McGlashan College
Kaiapoi High School
Kings High School
Lincoln High School
Mount Aspiring High School
Mount Hutt College
Mountain View High School
Nelson College for Girls
Northern Southland College
OTHER (If not on list please enter in section below)
Otago Boys High School
Oxford Area School
Papanui High School
Rangiora High School
Shirley Boys High School
South Otago High School
Southland Boys High School
St Andrews College
St Bede's College
St Peters College
St Thomas's of Canterbury
Timaru Boys High School
Upper Moutere School
Waimate High School
Waitaki Boys HIgh School
Wakatipu High School
Weston Primary School
School Name (If not listed above please complete)
MNZ Licence # or OE if One Event Lic required
One Event Licences supplied by MNZ - No charge
Comments or Queries
Note: One event licences provided free of Charge by MNZ
All Classes Entry Fee $65.00
Own Transponder (provide pin number) Deduct $5
Tick if One Event Licence Required - No Charge
One Event Licence required - No Charge (must be countersigned on the day by Parent/Guardian 18years or over)
Intended Payment Method
Cheque Being Sent
Total Payment $
If rider is under 16 years of age on race day
or under 18 years & requires a One Event Licence
Parent/Legal Guardian Name
to Read the terms and conditions (Supplementary Regulations and general information for the event)
I have read and accepted Disclaimer of Liability & Supplementary Regulations for this event
I confirm information I have supplied is correct
Click here to Download School Registration Form
Remember to email completed form to firstname.lastname@example.org
I understand that my entry is not valid until School Principal has verified my eligibililty by completing Registration Form
CLICK HERE to Download the Bike & Safety Gear Checklist
I have read the Bike & Safety Gear Checklist and understand I need to meet these requirements to compete in this event
Cheques payable to – Gore & Districts Motorcycle Club, and post to
SI & Southland Secondary Schools MX
38 Davisons Road
Direct Credit – GDMCC 03-0915-0256944-00
(Please include class & name & 'SISS' as ref with payment)
DISCLAIMER OF LIABILITY
: To Gore & Districts Motorcycle Club, and Motorcycling New Zealand Inc.
I have read the Supplementary Regulations* for this Competition and agree to be bound by them and the Manual of Motorcycle Sport, the MNZ Constitution, and the MNZ Code of Conduct. * Supplementary Regulations also available at www.timingtech.co.nz
2. I am aware that the sport of Motorcycle Competition might a) cause me injury; serious or otherwise b) damage my property.
3. I wish to take part in the South Island & Southland Secondary & Schools Motocross despite the above risks.
4. Neither I, or anyone associated or connected with me will make any claim against you or your officers, employees or agents in respect of: a)any injury suffered by me; or b) any damage to any of my property regardless of how the injury or damage occurs.
5. I will indemnify you against all claims, damages or losses (including costs) which you incur as the direct or indirect result of any injury to me or damage to my property.
6. I am physically fit and there is no health or other reason why I should not participate in the sport of Motorcycle Competition.
7. I am aware that this disclaimer will not affect any legal obligations you have to me which you cannot contract out of under NZ Law.
8. I agree that in this disclaimer “my property” includes any property owned by me or in my possession or under my control.
9. I agree that this disclaimer will be binding on my family, my heirs, my legal assigns and my administrators and executors.
10. I accept that stripping and re-assembly for Technical Checks are at my cost.
11. I consent to the details contained in this form being held by the South Canterbury Motorcycle Club for the purpose of the promotion and the benefit of the race meeting concerned, and Motorcycling in general. I acknowledge my right to access and correction of this information. The consent is given in accordance with the Privacy Act 1993.
12. MNZ supports the FIM/IOC Charter on drugs in Sport. MNZ uses the services of Drug Free Sport NZ and other agencies to professionally carry out the testing. I acknowledge by signing this form I maybe subjected to a drug/alcohol test at any time. I agree to such testing. I further agree that my name can be published by MNZ as having taken part in a drug/alcohol test together with the results of that testing.
13. I confirm that my machine complies with any technical rule(s) set out in the Manual of Motorcycle Sport and/or the Supplementary Regulations and that, to the best of my knowledge and belief, it is in safe working order and fit for competition.
ONE EVENT LICENCE – I do not have a MNZ Competition Licence therefore require a One Event Licence for this event:
In the absence of holding a MNZ Competition Licence, I acknowledge that I am able to compete by partaking on a One Event Licence. By reading and acknowledging this disclaimer, the Supplementary Regulations and the following rules I acknowledge that I adhere to all conditions to compete at this event using the One Event Licence.
The ability to compete whilst using a one event licence may be withdrawn at any time by Motorcycling New Zealand.
I acknowledge that I will wear an approve helmet, along with approved boots, gloves, and motocross clothing as per the MNZ Manual of Motorcycle Sport – see
I acknowledge that no drugs or alcohol are permitted at this event, and I am not under the influence of either.
I acknowledge that I may be subject to random drug & alcohol testing as per the MNZ Manual of Motorcycle Sport.
I acknowledge that I have no medical condition that prevents me from safely participating in this event. I have not suffered concussion, or a head injury in the last three weeks.
My motorcycle is in a safe operating condition and type suited to the events that I am partaking in.
I acknowledge that attending riders briefing is compulsory
It is a condition of entry that all person having any connection with promotion, organisation, and conduct of the event including land owners, will be absolved from any liability out of any accident however caused and resulting in damage to property and or in respect of death or personal injury.
I fully indemnify Motorcycling New Zealand Inc., its agents representatives, employees, contractors, other competitors and promoters from and against any liability, whether or not due to any act or omission of these parties which arises from my participation in the event including by way of example any accident, damage or injury.
I agree that I have no medical condition that prevents me from safely participating in this event. I have not suffered concussion or had a head injury in the last three weeks. I acknowledge that should I suffer a head injury or concussion three weeks prior to this event that I will not partake due the MNZ stand down period.
Please make sure that you have filled out all * required fields. Your entry has been sucessfully submitted if this page converts to one thanking you for your entry (Allow approx 20 seconds to submit).
If you have missed a field "Please correct the highlighted fields" will appear below the Submit Entry, and the applic field will be outlined in Red.
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