INDEMNITY FORM ALJUNIED GRC DRAGON BOAT _ BEDOK RESERVOIR

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INDEMNITY FORM ALJUNIED GRC DRAGON BOAT _ BEDOK RESERVOIR Powered By Docstoc
					                                   INDEMNITY FORM

   ALJUNIED GRC DRAGON BOAT @ BEDOK RESERVOIR


1. Please fill In your particulars

Name:

NRIC/ Passport No:                             Date of Birth:

Gender : Male / Female       Address:

                                                                            S(              )

Tel (O):                        Tel (H):                        Tel (HP):

Email address:

Organisation you are representing:


Please indicate the nature of your usage: Recreational / Training / Competition


In Case of Emergency, we should contact

Name:        Unai Rodriguez

Relation:    He is Spanish Armada’s Captain

Tel(HP):     906 903 64


3. Indemnity of Participant (Consent of Parent / Guardian for participants below 21
years old)

I, ________________________________ holder of NRIC/ Passport No.
(*pink/blue), shall not hold Aljunied GRC’s Citizens’ Consultative Committees (CCCs) or other
Grassroots Organisations (GROs), Public Utilities Board, National Parks Board, Singapore Land
Authority and other Government Ministries / Statutory Boards, responsible for any damage to or loss
of property or any injury or loss of life which may be sustained by myself during the activities or arising
from or in connection with the above event. I further declare and confirm that I am currently not
suffering from any acute ailments or diseases and I am fit to participate in the above event.




Signature of participant/Parent/Guardian                                             Date

				
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posted:9/19/2011
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