SAA-FRM-935Indemnity FormRelease 2.0
INDEMNITY FORM
I wish to join the
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from _________________ to _________________ and abide by the Rules and Regulations set by boththe Singapore Polytechnic and the Event Organising Committee. I am fully aware of the possible risksinvolved and accept the same, notwithstanding the fact that this course/activity/trip is intended onlyfor those without medical problems and who are fit enough to indulge in physical activities. I confirmthat I am enrolling on my own volition and I shall not hold the Singapore Polytechnic, its servants andorganisers responsible or in any way liable for my death, injury, disability or any loss or damagewhatsoever arising from any cause in connection with the course/activity/trip or my participationtherein.I hereby indemnify and agree to keep the Singapore Polytechnic, its management, servants andorganisers of the event fully indemnified against all claims, loss or damage whatsoever in respect of death, injury, disability or any loss or damage whatsoever arising from any cause in connection withthe course/activity/trip or my participation therein.
Personal Particulars
Name : Gender* : Male / FemaleAddress :Adm No : Course/Class: __________________ NRIC no. :Email : Date of Birth :Home No : Handphone No:_______________________ __________________Signature Date
……….…………………………………………………………………………….……………………
Parent’s/Guardian’s Consent for Participan
t below 21 years of age on date of the Enrolment
I consent to the above applicant, who is my child/ward* participating in the above camp and accept alllegal and other responsibilities connected with the course/activity/trip, as outlined above.I hereby indemnify and agree to keep the Singapore Polytechnic, its management, servants andorganisers of the event fully indemnified against all claims, loss or damage whatsoever in respect of
my child’s/ward’s death, injury, disability or any loss or damage what
soever arising from any cause inconnection with the course/activity/trip
or his/her participation therein.
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Full Name of Parent/ Guardian* Signature______________________ ______________________________ _______________NRIC/Passport* No Contact No.
(in case of emergencies) Date
* Please delete accordingly
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