BUDIWANGSA RESOURCES

(SA 0265793-A) Event Consultant

KARAT ADVENTURE
(001999846-P) Mountain Guide

REGISTRATION FORM
Participant’s Details:
Full Name:
IC No. /Passport No.: Contact No. (M):
Email: Contact No. (H):
Address:
For Foreigner & Expatriates, Birth Date:
Emergency Contact:
Name:
Relation with participant: Contact No. (M):
Outdoor Event Experience (i.e. Mount climbed, Marathon, Rock Climbing, etc.):
1.
2.
3.
The organizer reserves the right to decline participation on any event by any individual.

LETTER OF INDEMNITY
Statement of Responsibility & Indemnity:
I wish to take part in this event and hereby declare that
I shall abide by the rules and regulations as set by the organizers.

By joining this event, I also accept that

I participate in the event entirely at my own risk.
I hereby indemnify and save harmless to
KARAT ADVENTURE & BUDIWANGSA, the administrators, and organizer/s (individual/group)
from and against any and all
claims, demands, actions, suits, losses, costs, charges, expenses, damages, and liabilities
before, during and after the events of any nature of whatsoever and howsoever caused to me
which I may pay, sustain, suffer or incur arise from any/all injury/ies, illness/ess, damage/s, loss/es, mishap/s,
accident/s or any other occurrence/s,
resulting from my participation in any expedition, field trip, event, activity, and traveling to and from the event or
activity location.
*Participant below 17 years old need to have Legal Guardian’s Approval and signature below
I _____________________________________
Participant’s Signature: ________________________ IC _____________________ (Father/Mother/Legal guardian)
of this
Name: participant, being informed of this event/activities.
________________________ I’m aware of the risk of all activities organize by
Karat
IC: Adventure (mountain guide) and hereby
________________________ consent, agree and approve with the input in Letter of Indemnity.
I approved
Date: in all organizer’s future decision/s
________________________for this participant in any emergency/ies situation.

Parent’s Signature: ___________________ (for participant under 17 Years old)

NO. 27-ACD, Block C, Persiaran MPAJ, Jalan Pandan Utama, Pandan Indah, 55100 Kuala Lumpur

T (O):+603-42877543 (M): +6012-2097756, +6017-8812033 E uncle_karat@yahoo.com FB Karat Adv