RAINFOREST SURVIVAL CAMP

RELEASE OF LIABILITY AND ASSUMPTION OF RISK

To,
HIKERS CLIMBER ADVENTURE TEAM SDN BHD (602467 K),
Their partners, directors, employees, instructor and agents.

Re: ECO – ADVENTURE PROGRAM

I understand that I’m required to read carefully and sign a Release of Liability and Assumption of Risk form before RAINFOREST SURVIVAL
CAMP Hikers Climber Adventure Team Sdn Bhd (602467 K), their instructor, their agent(s) and/or their employee(s) will accept for myself/ son/
daughter for RAINFOREST SURVIVAL CAMP AT HUTAN LIPUR HULU PERDIK, ULU LANGAT on 15 - 17 MARCH 2011

I understand that the program is an adventure sport and may involve some risky activities. I am aware that adventure sport involves inherent
risk of illness, injury, death and/or lost or damage of property, which may be caused by negligence, force of nature or other causes known or
unknown. I recognize that such risks are present at any time, before, during and after the program. I am also aware that medical services or
facilities may not be readily available during the program.

IN CONSIDERATION OF, and as part of the agreement for the opportunity participate in the program, the activities, and services. I (Releaser)
agree to HOLD HARMLESS and RELEASE Hikers Climber Adventure Team, its instructor, officers, owners, directors, employees, agents,
associates and suppliers(Releaser) from and for all accidents, claims, losses, damages and liabilities (including without limitation, death,
liability, injury, loss/damage to the releaser and their property) which might occur during the program including without limitation to those
losses arising out to the strict liability or the joint or concurrent passive negligence or the Releasers. I expressly assume any and all such risks
with respect to the program and the activities and circumstances described herein and pledge and undertake not to sue the releases or any
one or more of them on account of any such losses, claims, costs, liabilities or damages, and further, I agree that the foregoing shall be
binding upon me personally and my family, as well as upon my estate, heirs and personal representative. I also agree that the Malaysian Law
shall govern this agreement.
I hereby sign on the attached list in agreement for the above release of liability and assumption of risk.

Name of Participant : IC No :

Signature of Participant : Date :

Name of Parents/Guidance : IC No :

Signature of Parents/Guidance: Date :

Witness by HCAT: IC No :
AHMAD HAFIZ ISMAIL
Signature : Date :

Address: ………………………………………………………………………………….…..
………………………………………………………………………………….…..

Telephone: ……………………….. Mobile: …………………………….

Sex : ……………………….. Age: …………………………….

Any health or medical condition that requires attention?

……………………………………………………………………………………………..

Any Food / drink allergies? …………………………………………………………..

Swimming Ability: YESMethod

Registration/Payment / NO

Please fax all Entry Forms to HCAT fax no: 03-55111787..

Payments can be made via cheque or by crediting into HIKERS CLIMBER ADVENTURE TEAM
SDN. BHD.’s Maybank A/C no. 512101268322. All payments must be received latest by 12 MARCH
2011 (closing date for entries). Kindly fax a copy of the bank-in-slip together with your entry form
for our reference.
 HIKERS CLIMBER ADVENTURE TEAM SDN BHD [602467 K]
Enquiries: 012 2878787 / 03 55101787 / 03 55 111 787(fax)
SHAH ALAM EXTREME PARK, SECTION 13, 40000 Shah Alam.
Email: hikersclimber87@yahoo.comWebsite: www.hikersclimber.com

GOALS
Have save fun
Attempt to work as a team
Take care of your self and others
“ Stretch” personally beyond known limits
Be respectful of others, always recognize individual differences

RAINFOREST SURVIVAL CAMP

VENUE: HUTAN LIPUR HULU PERDIK,
ULU LANGAT
15 - 17 FEB 2011
Fees:
30pax = RM 250.00 per person
50 pax = RM 190.00 per person
100 pax = RM 150.00 per person

Activities:
• Survival Course & Skill
• Water Based : Water Technique and Confident
• High Rope : Flying Squirrel / Flying Fox
• Leadership & Motivation
• Archery
• Paintball - Strategic Game
• Indoor Activity : Management & Creative Thinking Games
Things to Bring:
√ T Shirts √ Jacket/Wind Breaker √ Sleeping Bag/Mat
√ Track bottom √ Rain Coat √ Shower Equipment √
Stationery√ Sock √ Prayer Clothes √ Personal Medication
√ Shoes [2 pair] √ Sandal √Torch Light √ Towel √ Water
bottle Package:
Qualified Instructor and Facilitator
Insurance
Camping and Climbing Equipment
Transportation:
Pick up Point: Food and Beverage
Certificate
Shah Alam Extreme Park, Seksyen 13 – Transportation
8.30 am [ 14 MARCH 2011]