CLIMB X 2010 Indemnity Form

Temasek Junior College Climbing Competition

8th and 9th May

Personal Particulars

Full Name: ________________________NRIC/Passport No.: ___________

School: ___________ DOB (DD/MM/YY):__________Gender: Male/Female

Contact No.:___________________ Email: __________________________

Address: _____________________________________________________

I, hereby undertake to indemnity against Temasek Junior College against all claims arising out
of any death, injury, damage, loss suffered or caused in the course of participation in Climb X
2010, including all costs and expenses incurred as a result of such claims.

________________________ ________________
Participant’s Signature Date

Parent’s/Guardian’s Consent (For participants below 21 years of age)

I, __________________________________, NRIC/Passport No._______________, hereby

allow my child/ward* named above to participate in Climb X 2010. I unconditionally and
irrevocably undertake to Temasek Junior College that I will not in any way whatsoever hold
Temasek Junior College or its servants responsible for any death, injury, damage, and loss
suffered or caused in the course of the event. Such damage to or loss or property or any injury
or death is not caused by the negligence or willful act or omission of Temasek Junior College or
its servants.

________________________ ________________
Parent’s/Guardian’s Signature Date

* Delete where applicable

In case of an Emergency

Contact Person:________________________ Relationship: ____________

Home Tel:____________ Office Tel:___________ HP No.: ______________

Address:_____________________________________________________