INDEMNITY FORM

I wish to join the SP Gusto “Bring it On!” Freshmen Cheerleading Bonding Camp organised by SP
Cheerleading, Gusto from 22nd to 23rd May 2009 (Friday to Saturday) and abide by the Rules and
Regulations set by both ___________________ and the Event Organising Committee. I am fully aware
of the possible risks involved and accept the same, notwithstanding the fact that this trip/activity 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 ____________, its
servants and organisers responsible or in any way liable for my death, injury, 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 __________________, 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 or damage whatsoever arising from any cause in connection with the
trip/activity or my participation therein.

Personal Particulars

Name : Gender* : Male / Female

Address :

Adm No : Course/Class: __________________ NRIC no. :

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 Singapore Polytechnic, 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* Signature

______________________ ______________________________ _______________

NRIC/Passport* No Contact No. (in case of emergencies) Date
* Please delete accordingly

SAA-FRM-935 Release 3.0

Indemnity Form