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Ferrari Driver Academy Asia Pacific/OceaniaD R I V E R A P P L I C A T I O N

1300 883 959 motorsport.org.au pg. 2

Ferrari Driver Academy Asia Pacific/Oceania Driver Application

Please complete the following details for Ferrari Driver Academy Asia Pacific/Oceania Driver Application.Please attach any supporting documents relating to this request and you are entitled to add a separate presentation confirming applicant’s experience and history on no more than six A4 single sided pages.

GIVEN NAME(S)

GIVEN NAME(S)

GIVEN NAME(S)

LAST NAME

LAST NAME

LAST NAME

RELATIONSHIP

DATE OF BIRTH — —

Applicant Details

Parent or Guardian

Emergency Contact

ADDRESS

NATIONALITY

NATIONALITY

ADDRESS

SUBURB

SUBURB

STATE

NRIC/FIN/PASSPORT/I.C. NO.

STATE

POST CODE

POST CODE

GENDER

COUNTRY

COUNTRY

EMAIL

EMAIL

EMAIL

PHONE

PHONE

PHONE

1300 883 959 motorsport.org.au pg. 3

Ferrari Driver Academy Asia Pacific/Oceania Driver Application

CURRENT RACING MEMBERSHIP LICENCE NUMBER

COUNTRY

NAME OF SECONDARY SCHOOL

LICENCING ORGANISATION

LICENCE GRADE

LICENCE EXPIRY

ADDRESS OF SCHOOL

Licencing and Membership

Education

Indicate your highest academic achievements

Detail any sport, clubs or organisations you either play or were involved in

Driver’s Referee

REFEREE NAME

REFEREE PHONE

REFEREE TITLE

REFEREE EMAIL

Endorsement National Sporting Authority (ASN)

ENDORSEMENT NATIONAL SPORTING AUTHORITY (ASN) NAME

NATIONAL SPORTING AUTHORITY (ASN) PHONE

POSITION OF ASN REPRESENTATIVE

NATIONAL SPORTING AUTHORITY (ASN) EMAIL

SIGNATURE OF ASN REPRESENTATIVE S I G N H E R E

1300 883 959 motorsport.org.au pg. 4

Ferrari Driver Academy Asia Pacific/Oceania Driver Application

Key Fitness Matrix

Muscular Endurance

Core

Aerobic Capacity and Cardiovascular Endurance

HELMET SIZE Measure head circumference 2.5cm above the eyebrows around the largest point on the back of your head

WEIGHT (KG)

MAXIMUM PUSH UPS – 2 MINS

MAXIMUM TIMED PLANK

2KM TIMED RUN

WAIST Circumference top of hip bones (2.5-3.5cm below belly button)

DISTANCE WAIST TO HEEL

SLEEVE Base of neck to wrist, measure with elbow slightly bent, arm parallel to floor

CHEST Circumference under arms

HEIGHT (CM)

MAXIMUM BODY WEIGHT SQUATS – 2 MINS

MAXIMUM SIT UPS – 2 MINS

TRUNK top of breastbone to (4 way seam) at crotch

SHOULDERS Shoulder tip to shoulder tip

DISTANCE SHOULDER TO FINGERTIPS

BEEP TEST SCORE

INSEAM Crotch to anklebone (measure while wearing underwear)

Be sure to take all measurements over well fitting underwear, do not measure over baggy clothes. Make all measurements using either a cloth tape or string, then measure the string.

Provide all dimensions in cm

BEEP TESTPlease complete a standard 20m beep test based on this criteria: https://www.beeptestguide.com/table.htm

instructions for performing the test found here: https://www.beeptestguide.com/procedure.htm

results reported in this format: https://www.beeptestguide.com/results.htm

1300 883 959 motorsport.org.au pg. 5

Ferrari Driver Academy Asia Pacific/Oceania Driver Application

List any relevant driving experience and history in the box below. Include best results and championship details for the past two years.

Driver’s Experience/History

Criteria

In order to qualify for Motorsport Australia Ferrari Driver Academy, please confirm that you are aged between 14 – 17 years of age.

1300 883 959 motorsport.org.au pg. 6

Ferrari Driver Academy Asia Pacific/Oceania Driver Application

Medical Declaration

Please tick if you have any significant or recurrent problems with the following:

ANXIETY/DEPRESSION OR OTHER MENTAL HEALTH CONDITION

DIABETES

EPILEPSY

FITS/FAINTING/DIZZINESS

HEADACHES/MIGRAINE/HEAD INJURY

HEART DISEASE

DO YOU SUFFER FROM ANY ALLERGIES?

HEARING LOSS OR DEAFNESS

DO YOU WEAR GLASSES OR CONTACT LENSES WHEN DRIVING?

IS THERE ANY OTHER RELEVANT MEDICAL INFORMATION THAT YOU WISH TO ADVISE?

Motorsport Australia may request further information from you before accepting your application.

If you have ticked any of the above, you are required to provide additional information below relating to your condition.

Please tick if you are affected by any of the following conditions:

If you have ticked any of the above, you are not required to provide information relating to these conditions and can continue with your application.

Declaration

S I G N H E R E

S I G N H E R E

DATE

DATE

APPLICANT’S SIGNATURE

PARENT/LEGAL GUARDIAN SIGNATURE

—

—

—

—

The information I have entered into this form is true and correct and I will advise Motorsport Australia immediately if any of the information I have given is no longer true and correct. I have read, understood, acknowledge and agree to the above including the exclusion of statutory guarantees, warning, assumption of risk, release and indemnity.