WAIVER, RELEASE AND INDEMNITY AGREEMENT

(To be signed by the Parent/Guardian of the Youth / Leo Leadership Camp Candidate)
The Organizing Chairman
Youth / Leo Leadership Camp
Lions Club of Petaling Jaya
Leo Club of Petaling Jaya Integrity (O)
Dear Sir/Madam,
Re: Waiver, Release and Indemnity Agreement for the participation of the Youth / Leo Leadership Camp.
For and in consideration of permitting my son/daughter/ward:
Name

: __________________________________________________________________________________________________________

NRIC No : ________________________________________________________________________________________

(the candidate)

To enrol in and participate in the Youth / Leo Leadership Camp

To be held at
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Commencing from: _____________________________ to: ___________________________________
Organized jointly by the Lions Club of Petaling Jaya & Leo Club of Petaling Jaya Integrity (o)
Name of (Parent/Guardian)
___________________________________________________________________________________________________________________
NRIC No: __________________________________________________________________________________________________________
Address:
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
(the Parent/Guardian) hereby voluntarily release, discharge, waive and relinquish any and all actions or causes of action for personal injury, or
wrongful death occurring to the Candidate arising as a result of enrolling, participation in the above said Youth / Leo Leadership Camp or any
activity incidental there to wherever or however the same may occur and for whatever period the said activities may continue and the
undersigned does hereby releases, discharges, waives and relinquishes any action or causes of action, aforesaid, which may hereafter arise to the
candidate, and agrees that under no circumstances will he/she prosecute or present any claims for personal injury or wrongful death sustained or
occurred to the Candidate against the Lions Club of Petaling Jaya & Leo Club of Petaling Jaya Integrity (o), its Officers, Agents, Servants or
Employees, its Members, Agents or Servants for any of the said causes of the said person or otherwise.

IT IS THE INTENTION OF ME
(Name of Parent/Guardian)

: ________________________________________________________________________________________

NRIC No

: ________________________________________________________________________________________

BY THIS INSTRUMENT, TO EXEMPT AND RELIEVE THE LION CLUB OF PETALING JAYA & LEO CLUB OF PETALING JAYA
INTEGRITY (O) FROM LIABILITY FOR PERSONAL INJURY OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR OTHERWISE
OCCURRING TO THE CANDIDATE.
The undersigned, for him/herself, agrees that in the event any claim for personal injury or wrongful death occurring to the Candidate shall be
filed and/or prosecuted against the Lions Club of Petaling Jaya and Leo Club of Petaling Jaya Integrity (O), he/she shall indemnify and save
harmless the Lions Club of Petaling Jaya and Leo Club of Petaling Jaya Integrity (O) from and against any or all claims, causes of action,
proceedings, loss, damage, fines, penalties, liabilities, fee, charges and costs (including Solicitors fees and cost on a Solicitor and Client basis)
by whomsoever or wherever made or presented for personal injury or wrongful death occurring to the Candidate.
The undersigned acknowledges that he/she has read the foregoing two paragraphs, has been fully and completely advised of the potential dangers
incidental to engaging in the activities of the above mentioned Youth/Leo Leadership Camp by the Candidate and is fully aware of the legal
consequences of signing the within instrument.

Dated this day of

20/____

Signature of Parent/Guardian

: _____________________________________

Name

: _______________________________________________________________________________

NRIC No

: _______________________________________________________________________________

Address

: _______________________________________________________________________________
_______________________________________________________________________________

Post Code

: _______________________________________________________________________________

Signature of Witness

: ______________________________________

Name

: _______________________________________________________________________________

NRIC No

: _______________________________________________________________________________

Address

: _______________________________________________________________________________
_______________________________________________________________________________

Post Code

: _______________________________________________________________________________

* To be witnessed by person of full age (above 18) other than your spouse and immediate family member.

WAIVER, RELEASE AND INDEMNITY AGREEMENT

(To be signed by the Parent/Guardian of the Youth / Leo Leadership Camp Candidate)

Dear Sirs,
Re: Waiver, Release and Indemnity Agreement for the participation of the Lions Club of Petaling Jaya and Leo Club of Petaling Jaya Integrity
(o)
For and in consideration of permitting me:
Name

: __________________________________________________________________________________________________________

NRIC No : _________________________________________________________________________ __________________ (the candidate)

To enrol in and participate in the Youth / Leo Leadership Camp
To be held at
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Commencing from: _____________________________ to: ___________________________________
Organized jointly by the Lions Club of Petaling Jaya & Leo Club of Petaling Jaya Integrity (o)
I, hereby voluntarily release, discharge, waive and relinquish any and all actions or causes of action for personal injury, or wrongful death
occurring to the Candidate arising as a result of enrolling, participation in the above said The Youth / Leo Leadership Camp or any activity
incidental thereto wherever or however the same may occur and for whatever period the said activities may continue and the undersigned does
hereby releases, discharges, waives and relinquishes any action or causes of action, aforesaid, which may hereafter arise to the candidate, and
agrees that under no circumstances will he/she prosecute or present any claims for personal injury or wrongful death sustained or occurred to the
Candidate against its Officers, Agents, Servants or Employees, its Members, Agents or Servants for any of the said causes of the said person or
otherwise.

IT IS THE INTENTION OF ME
(Name of Parent/Guardian)

: _________________________________________________________

NRIC No

: _______________________________

BY THIS INSTRUMENT, TO EXEMPT AND RELIEVE THE LIONS CLUB OF PETALING JAYA AND LEO CLUB OF PETALING
JAYA INTEGRITY (O) FROM LIABILITY FOR PERSONAL INJURY OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR
OTHERWISE OCCURRING TO THE CANDIDATE.
The undersigned, for him/herself, agrees that in the event any claim for personal injury or wrongful death occurring to the Candidate shall be
filed and/or prosecuted against the Lions Club of Petaling Jaya and Leo Club of Petaling Jaya Integrity (O), he/she shall indemnify and save
harmless the Lions Club of Petaling Jaya and Leo Club of Petaling Jaya Integrity (O) from and against any or all claims, causes of action,
proceedings, loss, damage, fines, penalties, liabilities, fee, charges and costs (including Solicitors fees and cost on a Solicitor and Client basis)
by whomsoever or wherever made or presented for personal injury or wrongful death occurring to the Candidate.
The undersigned acknowledges that he/she has read the foregoing two paragraphs, has been fully and completely advised of the potential dangers
incidental to engaging in the activities of the abovementioned The Youth / Leo Leadership Camp by the Participant and is fully aware of the
legal consequences of signing the within instrument.
Dated this day of

20/_____

Signature of Participant: ________________________

Name

: ____________________________________________________________________________________

NRIC No

: ____________________________________________________________________________________

Address

: ____________________________________________________________________________________
____________________________________________________________________________________

Post Code

: ____________________________________________________________________________________

Signature of Witness : ________________________

Name

: ____________________________________________________________________________________

NRIC No

: ____________________________________________________________________________________

Address

: ____________________________________________________________________________________
____________________________________________________________________________________

Post Code

: ____________

* To be witnessed by person of full age (above 18) other than your spouse and immediate family member.