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Youth Academy Registration 2023

€50.00

Programme *

Kart Programme Mini Age 8-12
Kart Programme Junior Age 13-16
Youth Programme (Must be able to drive) Age 14-21

Student Name *

First

Last

Address *

Age *

Date of Birth *

School/College and Class/Year

Have you ever held a Motorsport Ireland Licence

Yes
No

Have you previously been a student of the Youth Academy?

Yes
No

Do you have any motorsport experience of any kind? Give details below

Any Medical Conditions/Learning Difficulties/Other we should be informed about? (eg diabetes, asthma, dyslexia, ADHD)

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Contact Number *

Parent/Guardian Wexford Motor Club Member? *

Yes
No

By registering I agree to abide by the constitution, code of conduct and policies of Wexford Motor Club *

I agree to receive communication from Wexford Motor Club for the purpose of administering my membership and to inform me of club or other events which may be of interest to me a member of the club.

Signature *

By signing this, I acknowledge that I have read, understand, and agree to the policies and procedures given to me by County Wexford Motor Club CLG.

Checkbox Items *

Membership Fee - 50,00 €

Stripe Credit Card *

Card

Name on Card

Youth Academy Registration 2023 quantity

— OR —

Category: Uncategorised

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