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ST. JOHN AMBULANCE SINGAPORE

ST. JOHN AMBULANCE BRIGADE

For The Service of MankindPatron: The President of the Republic of Singapore

National Day Parade 2009 (Marching Contingent)INDEMNITY FORM

RELEASE OF LIABILITY

I understand that elements in the National Day Parade 2009, which requireme to march a total distance of 2.4 km, may be physically and emotionallydemanding. I affirm that my health is good, and that I am not under aphysician's care for any undisclosed condition that bears upon my fitnessto participate in the Marching Contingent for National Day Parade 2009. Irecognize that there may be inherent risk and disability in this activity. Iunderstand that a participant must assume the risk of injury that couldresult from any of these activities. I release St. John Ambulance Brigade(SJAB), the Singapore Arms Forces (SAF) and all staffs from any liability forany injury to me from the participation of National Day Parade 2009.Participant’s Name: ___________________________________________ Participant’s NRIC: ___________________________________________ Participant’s Signature: ___________________________________________ Address: _____________________________________________________ Telephone: _____________________________________________________

FOR PARTICIPANTS 21 YEARS OLD AND BELOW

Parent / Guardian’s Name : ______________________________________ Parent / Guardian’s Signature : ___________________________________ Parent / Guardian’s Contact Number : _____________________________

In Case of Emergency,

Please do Contact (Name) _________________________ ________________________ (Contact). Thank you.

420 Beach Road. Singapore 199582Telephone: 6298 0300 (Office hour) 6293 9574 Fax: 6296 5797