INDEMNITY FORM I wish to join the

(trip/activity/camp) organised by from 12th to 14th April 2016 and abide by the Rules and Regulations set by both the Fellowship of Evangelical Students (FES) and the Event Organising Committee. I am fully aware of the possible risks involved and accept the same, not withstanding the fact that this trip/activity/camp is intended only for those without medical problems and who are fit enough to indulge in physical activities. I confirm that I am enrolling on my own volition and I shall not hold the Fellowship of Evangelical Students (FES), its servants and organisers responsible or in any way liable for my death, disability or any loss or damage whatsoever arising from any cause in connection with the trip/activity/camp or my participation therein. I hereby indemnify and agree to keep the Fellowship of Evangelical Students (FES), its management, servants and organisers of the event fully indemnified against all claims, loss or damage whatsoever in respect of death, injury, disability or any loss of damage whatsoever arising from any cause in connection with the trip/activity/camp or my participation therein.

Personal Particulars Name:

Gender*: Male / Female

Address: NRIC No.:

Polytechnic:

Admission No.:

Year (AY 16/17)**: 1 / 2 / 3

Course:

Email:

Date of Birth:

Home No.:

Handphone No.:

Signature

Date

……………………………………………………………………………………. Parent’s/Guardian’s Consent for Participant below 21 years of age on date of the Enrolment I consent to the above applicant, who is my child/ward* participating in the above trip/activity/camp and accept all legal and other responsibilities connected with the trip/activity/camp, as outlined above. I hereby indemnify and agree to keep the Fellowship of Evangelical Students (FES), its management, servants and organisers of the event fully indemnified against all claims, loss or damage whatsoever in respect of my child’s/ward’s death, injury, disability or any loss or damage whatsoever arising from any cause in connection with the trip/activity/camp or his/her participation therein.

Full Name of Parent/ Guardian*

NRIC/Passport* No. * Please delete accordingly

Signature

Contact No. (In case of emergencies) ** AY 16/17 – Academic Year 2016/2017

Date