PARENTAL WAIVER AND RELEASE FORM

As a parent or legal guardian of the child named below, I hereby give my

full consent and approval for my child to participate as a participant in
the Larian Amal Gaya Sihat 2019 that will be held on 8th September 2019
on Padang Merdeka Kota Kinabalu Sabah. I understand that there are
certain risks of injury inherent during the event, and I am willing to
assume this risks on behalf of my child. I hereby certify that my child is
fully capable of participating in this run event and that my child is
healthy and has no physical or mental disabilities or infirmities that
would restrict full participation in these run event.

In addition to giving my full consent for my child’s participation, I do

hereby waive release and hold harmless Mutiara Event, its officers,
sponsors and representatives for any injury that may be suffered by my
child in the normal cause of participation in the designated run and the
activities incidental thereto, whether the result of negligence or any
other cause.

Name of Child : ____________________________ Date of Birth : ___ / ___ / ___

Sex : ( Male / Female )

MyCard Number : _ _ _ _ _ _ - _ _ - _ _ _ _

Parent/Guardian’s name : ________________________ No. Phone :____________

Parent/Guardian/s signature : __________________________ Date : __________