Appendix I

MAINCOMM SUBCOMM BONDING EVENT 2013

REGISTRATION AND INDEMNITY FORM Event Na e! MAINCOMM SUBCOMM BONDING St"dent O#$ani%ati&n! COM'UTER ENGINEERING C(UB Event Date! 12 O)t&*e# 2013 1+'ARTICI'ANT,S 'ARTICU(ARS
Na e (as in passport)

NRIC N" *e# (Singaporeans/PR) 'a%%p&#t N" *e# &# FIN (Foreigners)
(If you are a student)

S).&&/ - C&"#%e

Yea# &0 St"d1

(pls check unchecked applications shall be rejected) I %.a// en%"#e t& *e 0"//1 a2a#e a*&"t 1 #e%p&n%i*i/it1 and a// #"/e%3 #e$"/ati&n%3 #e4"i#e ent% and in%t#")ti&n% $&ve#nin$ t.e Main)& S"*)& B&ndin$ Event 0#& t.e Event O#$ani%e#3 and a*ide *1 t.e %t#i)t/1+ Date &0 Bi#t. Gende# (pls circle) Male / Female 5dd-116

Mai/in$ Add#e%% '&%ta/ C&de C&nta)t N& E ai/ Add#e%%

(home) (mobile)

B/&&d G#&"p itati&n% (pls declare)!

A//e#$ie%3 I//ne%%e% 7 Medi)a/ (i

Dieta#1 Re4"i#e

ent%

Halal

Vegetarian

No restriction

2+'ERSON TO NOTIFY IN CASE OF AN EMERGENCY

Na e Re/ati&n%.ip '&%ta/ C&de C&nta)t N& E ai/ Add#e%% [Page 1 of 2]
(home) ) (mobile

Mai/in$ Add#e%% S
(office)

3+TY'ES OF ACTIVITIES AND 'OSSIB(E IN8URIES

Programme of may incl !e "hysical an! team#b il!ing acti$ities% Some "ossible in& ries incl !e c ts' br ises' s"rains' m scle strains' an! heat e(ha stion% Safety is o r "rimary concern an! )e ta*e all "reca tions to g ar! against in& ry% +f yo are not feeling )ell or ha$e s staine! an in& ry' "lease inform the ,$ent -rganiser or First .i!er imme!iately% 1/

Appendix I
+f yo ha$e a me!ical history or an e(isting me!ical con!ition an! are not certain if yo can "artici"ate in the more rigoro s acti$ities' "lease refrain from "artici"ating ntil yo ha$e so ght clearance from yo r !octor% Please note that the cost of any me!ical treatment is to be borne by the "artici"ants%

INDEMNITY FORM 5t& *e %i$ned *1 pa#ti)ipant6

+ ac*no)le!ge an! agree that "artici"ation in the Maincomm S bcomm 0on!ing ,$ent comes )ith inherent ris*s% + ha$e f ll *no)le!ge of the foregoing ris*s an! ass me all s ch ris*s myself% +n consi!eration of my "artici"ation in the Maincomm S bcomm 0on!ing ,$ent' + shall not hol! 1,1' Nanyang 2echnological 3ni$ersity' its officers' agents an! em"loyees liable for any !amage to or loss of "ro"erty or any in& ry or loss of life )here s ch !amage to or loss of "ro"erty or any in& ry or loss of life is not ca se! by the negligence of 1,1' Nanyang 2echnological 3ni$ersity' its officers' agents an! em"loyees% + n!erta*e to ens re strict com"liance )ith all r les' reg lations' re4 irements an! instr ctions relate! to the Maincomm S bcomm 0on!ing ,$ent + n!erstan! that' sho l! + be a!mitte! to the Maincomm S bcomm 0on!ing ,$ent on the basis of any false or inacc rate information !eclare! by me' + may ren!er myself liable to any a""ro"riate action an! s ch false or inacc rate !eclaration may res lt in the $oi!ance of any ins rance claim arising from or in connection )ith the Maincomm S bcomm 0on!ing ,$ent 555555555555555555555555555555 Name of "artici"ant 55555555555555555555 Signat re 555555555555 6ate

'a#ent,% &# G"a#dian,% Unde#ta9in$ (To be completed if the participant is below

the age of 21 years)

+' being the "arent' g ar!ian or "erson ha$ing the care an! c sto!y of 55555555555555 (name of participant)' !o consent that s/he may "artici"ate in the Maincomm S bcomm 0on!ing ,$ent an!' in consi!eration of 1,1' Nanyang 2echnological 3ni$ersity' its officers' agents an! em"loyees "ermitting him/her to so "artici"ate' n!erta*e that + )ill not' )hether on behalf of my chil! / )ar! or in my o)n right' hol! 1,1' Nanyang 2echnological 3ni$ersity' its officers' agents an! em"loyees liable for any !amage to or loss of "ro"erty or any in& ry or loss of life )here s ch !amage to or loss of "ro"erty or any in& ry or loss of life is not ca se! by the negligence of Nanyang 2echnological 3ni$ersity' its officers' agents an! em"loyees% 5555555555555555555555555555555555555555 Name of "arent' g ar!ian/"erson ha$ing 6ate the care an! c sto!y of the "artici"ant 55555555555555555555 Signat re 5555555555

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