Safety Check and Registration Form

Car Related Items
Roll Cage
(Minimum 1 inch to drivers helmet, no additions)
_____		   Brakes
(Heel Stop, Metallic outer shield brake line)		  
_____
(DQ) Seat/Shoulder Belts
(2 year maximum, SFA 16.1)              Date: ___________
_____		   Fuel System
(Minimum wire tie clamp)		  
_____
Nerf Bars/Bumpers
(Minimum 6/32 bolt, Grade 5 min.)
_____		   (DQ) Exhaust System
(DQ for all classes)		  
_____
Shoulder Bar
(Minimum 8/32 bolt at spud or clamp, Grade 5 min.)
_____		   Throttle Cable
(No Binding)		  
_____
Axle/Hubs
(Axels not past wheels, No Carbon Fiber)
_____		   Tail Cone
(below top of bumper)		  
_____
Belly Pan
(Minimum gauge 0.040 AL, No open holes)
_____		   Tires/Wheels
(Three lug nuts)		  
_____
Firewall
(Minimum gauge 0.048 AL, No open holes)
_____		   (DQ) Oil Catch Can
(Located under tail)		  
_____
Steering Wheel
(1 inch thick, 2 inch diameter pad, min.)
_____		   (DQ) Weights
(Only within main frame rails, No loose weights.)		  
_____
Steering
(No over center, binds)
_____		   (DQ) Side Panels
(2" hole for access to flywheel nut)
L_____
R____
Ignition System
(All securely fastened, Up for On)
_____		   Enclosed Nose Section
 		  
_____
      QMA Sticker
 		  
_____
Drivers Equipment
(DQ) Helmet
(Snell SA2000, SFI 24.1, CMR2007 (or higher))
_____		   (DQ) Wrist Restraint
(Worn close to wrist, not above elbow)
_____
Face Shield
(No cracks)
_____		   (DQ) Suit
(SFI 3.2A/1 minimum)
_____
(DQ) Jacket
(SFI 3.2A/1 minimum)
_____		   (DQ) Pants, if using Jacket
(Minimum denim, No pajama or sweat pants)
_____
(DQ) Neck Collar
(SFI 3.3)
_____		   (DQ) Shoes
(Completely cover feet, flat bottom)
_____
(DQ) Gloves
(SFI 3.3/5, 2 layer)
_____		      

General Safety Condition:   ________________________________________________

Safety Director Signature:   ________________________________________________

Registration

Date: __________________  Car #:   Color:

Class:   Novice    GX120    GX160    Superstock    Mod    B-Mod    AA-Mod    Briggs W/F    Half
Division:  Junior    Senior    Light    Heavy

Drivers Name:   Date of Birth:   Age:
Address:
City:   State:   Zip Code:
Handlers Name: Handler Phone:
Handler Address:
City:   State:   Zip Code:
QMA Region:   QMA Club:   Drivers #
Pit Fee Paid $ _________________  Insurance: K&K Insurance Group, Inc.

I agree to assume all responsibility at this event and to abide by all QMA rules/procedures.

Signature of Owner and/or Handler: ______________Please sign the printed copy______________

Note: (DQ) is reference to an item that is Disqualifiable item from race or timing event (Effective 4/01/08)

 

Color References:
Novice-Gold, Junior Honda-Yellow, Senior Honda- Orange, Heavy Honda- Salmon, Super Stock-Green,
Light 160-Light Purple, Heavy 160-Dark Purple, Mod-Blue, B-Mod-Tan, AA-Mod-Pink, W/F-White, Half-Teal