MSC Racing Association Pre-Race Inspection Check List and Participant Statement
Car Owner Name: ______________________________________________________
Current Member of MSC? Yes No Membership #: _______________
Member’s Current Address: _____________________________________________________
City/State/Zip ________________________________________________
Phone: Land: __________________________ Cell: ___________________________
Type of Car: Coupe Stock Modified Midget Sprint Other: _____________________
Engine: Make: ________________ Cylinders: ____________________ CU. IN.:________
Car Driver: Self: _____ Other: _____________________________________
Car Color: __________________________________________________
What Vintage is the Car? (Year it was originally built?) ______________________________
This Section to be completed by Inspector (circle Y or N)
Battery/Electrical: Y N Helmet: Y N Body: Y N
Mufflers: Y N Brakes: Y N Radiator and Hoses: Y N
Doors: Y N Roll Cage: Y N Drive Shaft Hoop: Y N
Seat Belts and Seat: Y N Electric Fuel Pump Shutoff: Y N Steering: Y N
Fire Extinguisher: Y N Suspension: Y N Firesuit/Safety Clothing: Y N
Throttle Pedal and Linkage: Y N Firewall: Y N Toe Strap: Y N
Fuel Cell and Lines: Y N Wheels/Tires: Y N Raceceiver: Y N
Updated January 14, 2018
Car Owner/Driver Statement: By signing this document, I acknowledge that I have read and I fully understand and agree with, this year’s version of the MSC Racing Association Pre Race Inspection Guidelines. I understand and acknowledge that vintage racing is inherently a dangerous sport. I hereby release the MSC Racing Association of any and all liability, regarding any damage that may occur to this race car or our equipment during this event. In addition, I hereby release the MSC Racing Association from any and all liability, should I or the car's crew be injured in any way, up to and including the loss of one's life. I accept full responsibility for the safety of the car and equipment and state that I will perform in a safe manner during the event and fully realize that if I don't, I could be asked to discontinue my participation and may be asked to leave the event without refund.
Signature of Participant – Owner __________________________________________ Date _______________________
Signature of Participant – Driver ___________________________________________ Date _______________________
Signature of MSC Racing Association Inspector ____________________________________ Date _________________