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Please do not use yet

Private Facility Maintenance Request Form

Please use this form to request access to RKC for undertaking maintenance work outside of an official working bee.

By completing and submitting this online form, I/We agree to abide by the Rules, Guidelines and Signage of the Rockhampton Kart Club Inc.

Attendance Date:

YYYY

Time of Arrival:

Hour

Minute

Second

Organiser of Works Name:

First Name

Last Name

Organise Phone Number:

Organiser Email:

Working Party Names:

Second Club Member / RKC Associate Details / Observer:

(In the interests of site safety, an observer over 18 years of age must be present while the intended work is occurring. The observer, if not a member of the Rockhampton Kart Club Inc. must complete a waiver form.) If the Observer / Associate share common contacts, mark "as above."

Observer/ Second Club Member / Associate Name:

First Name

Last Name

Observer / Second Club Member / Associate Phone Number:

(###)

###

####

Observer Address (if not a club member or Associate):

Observer Email (if not a club member or Associate):

Intended Maintenance Work To Be Completed:

Intended Consumables To Be Reimbursed By RKC:

DRAFT PAGE for testing

Please do not use yet

Private Facility Maintenance Request Form

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