CACC Medical Self-Declaration

CACC Medical Self-Declaration

This standalone CACC Medical Self-Declaration form is used by Karting, Ice Race, Race and Vintage license applicants when not required to submit a Physician Medical Examination form. Once you’ve completed and submitted the form, a PDF copy of the completed form will be sent to the email address you provide below.

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Name(Required)
Address(Required)
MM slash DD slash YYYY
Gender(Required)
Corrective Lenses Required(Required)

Medical Conditions

Check the box for each condition below that you have now or have had in the past. Provide any relevant details in the Notes section below.

Any known medical conditions which could affect your ability to participate safely in motorsport competition must be reported immediately.

Applicant's Declaration(Required)
      The Confederation of Autosport Car Clubs
      BC's FIA/ASN Canada Motorsport Sanctioning Authority