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SINGAPORE POLYTECHNIC INDEMNITY FORM wish to jointhe__(event) from_to__ and abide by the [Rules and Regulations set by both the Singapore Polytechnic and the Event Organising Committee. I am fully aware of the possible risks involved and accept the same, notwithstanding the fact that this course/aetivity/trip is intended only for those without medical problems and who are fit enough to indulge in physical activities. I confirm that I am enrolling on my own volition and I shall not hold the Singapore Polytechnic, its servants and organisers responsible or in any way liable for my death, injury, disability or any loss or damage whatsoever arising from any cause in connection with the course/activity/trip or my participation therein. hereby indemnify and agree to keep the Singapore Polytechnic, its management, servants and organisers 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 with the course/activity/trip ‘or my participation therein. Sex: Address : Adm No NRIC No: Course/Class: Date of Birth: Tel No: Pager No: Sone Date Parent's/Guardian’s Consent for Participant below 21 years of age on date of the Enrolment consent to the above applicant, who is my child/ward* participating in the above camp and accept all legal and other responsibilities connected with the course/activity/trip, as outlined above. Thereby indemnify and agree to keep the Singapore Polytechnic, its management, servants and organisers 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 whatsoever arising from any cause in connection with the course/activity/trip or his/her participation therein. Fall Name of Parent/Guardian* Signature NRIC/Passport* No ContactNo. Date’ * Please delete accordingly SAA-FRM-935. Indemnity Form Release 1.0