This form may take you 10 minutes to complete.

You will require the following information to complete the form:

parent/guardians personal particulars

THIS PORTION MUST BE COMPLETED BY YOUR PARENT / GUARDIAN

I, holder of
(Name of

No)

, their appointed staff or officials responsible for any mishaps, injuries or loss of
staff or officials against any actions, proceedings, liabilities, claims, damages and expenses by any party
howsoever arising out of or in connection with the above said activity.
Signature

______________________________

Date:

_______________________

* Delete Accordingly

CONTACT IN-CHARGE
Name:

______________________________

Contact:

_______________________

Department
______________________________

SCG-001-Ver1

22 Nov 2016