Returning Drivers Form

This is not competition driving, This is a high speed driving school, on a racetrack, under close supervision by instructors. While the overriding consideration during the operation of the event is safety, incidents may occur that could cause vehicle damage and/or personal injury. You will be driving in a class session with other students and instructors whose vehicles may be uninsured and/or unregistered.

You are totally responsible for the safe operation and safe mechanical condition of your vehicle. ProFormance Racing School, it's instructors, staff, and facility providers assume no responsibility in the event of an incident, of any kind, in the course of these events.

Damage Policy: In the unlikely event that you are involved in a mishap, you may be billed for damage to track facilities and/or fire extinguisher recharging fees.

Submission of this application is your acknowledgment of the above and agreement to attend under these conditions.

If you would prefer, you may print this form, fill it out and fax it to: 425-271-7232 or mail it to: PO Box 791 Bellevue, WA 98009
Date
Name
Address
City
State
ZIP
Home Phone
Work Phone
E-mail Address
Driver's License #
License State
License Expiration
Age
Car you'll be driving? *
* All convertibles require fixed rollover protection or DOT approved “pop-up” rollover device.
Pacific Raceway Experience
Other Track Experience
It is important for us to have complete medical and emergency contact information on file. Please complete the following section, which will only be shared with emergency response personnel as needed.
Birth Date (dd/mm/yyyy)
Year of Tetanus
Current Prescriptions
Medical Conditions
Allergies
Dentures
Asthmatic
Diabetic
Epileptic
Hemophiliac
Hearing Impaired
Hypertension
Primary Physician
Physician Telephone
City of Physician
Health Insurance Provider
Insurance Group Name
Emergency Contact
Relationship
Contact Phone
Cancellations: We require 14 days notice of cancellation. Failure to notify our office, either by telephone or writing, prior to 14 days of your reserved school date will result in forfeiture of your deposit. Payment in full required 7 days prior to scheduled program. No refunds are given for cancellation less than 7 days from scheduled date. Prices subject to change without notice. Sorry, but some restrictions may apply.