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ACKNOWLEDGEMENT OF RISKS AND WAIVER FORM Name:_______________________________________________ NRIC/Passport No.

: ____________________________________ I hereby agree to the following terms and conditions of my participation in Gravical 2012 (Event): 1. I have read, understood and accepted the Rules and Regulations applicable to the Event. 2. I fully understand and acknowledge the risks involved in my participation in the Event. I accept full responsibility and assume all such risks. 3. I hereby represent, warrant and undertake to SMU the following with full knowledge that they shall be relied upon by SMU in accepting my participation: a. my personal particulars disclosed herein are correct; b. I have no medical condition that would affect my safety and physical well being arising from my participation in this Event and that I am medically and physically fit and competent to participate in the Event; and c. I shall dutifully and fully abide by the Rules and Regulations of this Event and any applicable laws. 4. I confirm that the representations, warranties and undertakings above are true and correct, and unconditionally and irrevocably undertake that I shall not in any way whatsoever hold SMU or its servants or agents responsible for any losses, costs, or damages (including consequential or incidental losses) resulting from damage to or loss of any personal property or personal injury (save for personal injury or death resulting from the negligence of SMU or its servants or agents) that may arise as a result of my participation in the Event.

______________________________ Signature & Date

(TO BE COMPLETED BY PARENT/GUARDIAN* OF PARTICIPANT UNDER 18 YEARS OF AGE)


I, ___________________________________, NRIC/Passport No.__________________, hereby allow my child/ward* named above to participate in the Event. I unconditionally and irrevocably undertake to SMU that I will not in any way whatsoever hold SMU or its servants or agents responsible for any losses, costs, or damages (including consequential or incidental losses) resulting from damage to or loss of any personal property or personal injury (save for personal injury or death resulting from the negligence of SMU or its servants or agents) that may arise as a result of my childs/wards participation in the Event.

_______________________ Signature & Date

*delete where inapplicable

Medical Declaration Form


1 Do you have a history of / have you ever had
Chest pain, high blood pressure, heart problems such as heart murmur extra heart beat or other heart abnormality Asthma, bronchitis, tuberculosis, sinusitis, other lung problems Fits, epilepsy, fainting attacks, migraine, severe head injury Eye problems / poor vision Ear problems / deafness Nervous illness Diabetes Allergy to medicines / food / others Bone or joint injury A carrier status of any infectious disease Medical treatment within last two years Date of last / current Tetanus Immunization

Yes No If yes, give details

(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l)

Date:

2 3

Do you require Do you have

(a) Routine medication

(a) Any disability (E.g. physical) (b) Any other medical information of note State existing medical condition (if any) not listed above: