THE HIMALAYAN EXPLORERS’ CLUB. INDIAN INSTITUTE OF TECHNOLOGY, ROORKEE, MEMBERSHIP/ CONSENT /RISK CERTIFICATE FORM Date: To The Chief Advisor H HIT Roorkee, Roorke | wish to participate in the outdoor activities of the Hi nd that these are organized and undertaken by the Student groups themselves and I shall Participate with full self responsibility. 1 shall not hold that ialayan Explorers’ Club (HEC) including treks, tours and expeditions. 1 fully unders IIT Roorkee responsible for any loss or injury. | agree that once my name has been finalized by the DOSW, IITR for any activity, the advance made to the third party would not be refunded. Signature Name Class Enroll No. Local Address PHOTO Permanent Address .. Mobile PARE! 'S / GUARDIAN’S CONSENT Lam giving my consent towards the participation of my ward in various outstation activities and adventure sport as listed below which are organized by the HEC, IIT Roorkee. | understand that such expeditions are organized by Students groups themselves and HEC, IIT Roorkee is only a facilitator. Therefore, I shall not hold IIT Roorkee responsible in the event of any loss or injury to my ward, HEC Activities Yes No Long & Short Trek STI Name .MAMONE. ...B0RAH. > Rangering Expedition = Relationship ..... MOTHER > Paragliding ie Full Address 4.U 120%. 222RHG,, GARDENS > Rafting & Camping = PTL. CETY.... RAMP, DRALN® EAS 1, Rock Climbing Training - MUM 8 Fr: SereMobile ...1.16.12%0.413 > Commando Obstacle Course C Signature... Wea > Cycle Race =