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    Hall 14 FOC Indemnity Form

    Uploaded by

    XIVfoc
    This form is required when signing up for the Hall XIV Freshmen Orientation Camp. Please print out, fill in. and submit to your CGLs along with your camp fee.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd

    Hall 14 FOC Indemnity Form

    Uploaded by

    XIVfoc
    483 views4 pages
    This form is required when signing up for the Hall XIV Freshmen Orientation Camp. Please print out, fill in. and submit to your CGLs along with your camp fee.

    Copyright

    © Attribution Non-Commercial (BY-NC)

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    DOCX, PDF, TXT or read online from Scribd

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    This form is required when signing up for the Hall XIV Freshmen Orientation Camp. Please print out, fill in. and submit to your CGLs along with your camp fee.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    483 views4 pages

    Hall 14 FOC Indemnity Form

    Uploaded by

    XIVfoc
    This form is required when signing up for the Hall XIV Freshmen Orientation Camp. Please print out, fill in. and submit to your CGLs along with your camp fee.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 4

    HALL OF RESIDENCE FOURTEEN

    12th Junior Common Room Committee Nanyang Technological University 34 Nanyang Crescent, Singapore 637634 Telephone/Fax: 67950859

    FRESHMEN ORIENTATION CAMP 2013/2014


    REGISTRATION AND INDEMNITY FORM Hall 14 Freshmen Orientation Camp 2013/2014 Hall 14 Freshmen Orientation Camp Committee 2013/2014 Camp Dates: 31/07/13 - 04/08/13 1. PARTICIPANTS PARTICULARS
    Name (as in passport) NRIC Number (for local students) / Passport Number or FIN (for international students) School / Course accepted in NTU
    (pls check unchecked applications shall be rejected)

    Year of Matriculation

    I confirm that I have accepted a place in NTU as a student and therefore am eligible to participate in this Freshmen Orientation Camp. If otherwise, I shall inform the Camp Organiser before the Camp starts and withdraw my participation. I shall then forfeit any fees which I may have paid for the Camp. Gender (pls circle) Mailing Address Postal Code Contact No Email Address Allergies, Illnesses & Medical Limitations (pls declare):
    (home) (mobile)

    Male / Female

    Date of Birth
    (dd/mm/yy)

    Blood Group

    Dietary Requirements T-shirt Size

    Halal XS

    Vegetarian M L

    No restriction XL

    HALL OF RESIDENCE FOURTEEN


    12th Junior Common Room Committee Nanyang Technological University 34 Nanyang Crescent, Singapore 637634 Telephone/Fax: 67950859

    2. PERSON TO NOTIFY IN CASE OF AN EMERGENCY


    Name Mailing Address Postal Code Contact No Email Address
    (home) (mobile)

    Relationship S
    (office)

    3. TYPES OF ACTIVITIES AND POSSIBLE INJURIES


    Programmes of FOCs may include physical and team-building activities. Some possible injuries include cuts, bruises, sprains, muscle strains, and heat exhaustion. Safety is our primary concern and we take all precautions to guard against injury. If you are not feeling well enough for an activity or have sustained an injury, please inform your group leader or First Aider immediately. You also have the option to opt-out of activities you are not comfortable with. If you have a medical history or an existing medical condition and are not certain if you should participate in the more rigorous activities, you are advised to refrain from participating unless you have sought clearance from your doctor. Please note that the cost of any medical treatment is to be borne by the participants.

    4. IN CASES OF UNFORESEEN CIRCUMSTANCES


    In light of the current unpredictability of the haze situation, Hall 14 FOC 2013/14 reserves the right to shorten the camp or cancel the entire camp if the haze is deem to be hazardous for activities.

    HALL OF RESIDENCE FOURTEEN


    12th Junior Common Room Committee Nanyang Technological University 34 Nanyang Crescent, Singapore 637634 Telephone/Fax: 67950859

    INDEMNITY FORM (to be signed by participant)


    I acknowledge and agree that participation in Hall 14 Freshmen Orientation Camp 2013/2014 comes with inherent risks. I have full knowledge of the foregoing risks and assume all such risks myself. In consideration of my participation in Hall 14 Freshmen Orientation Camp 2013/2014, I shall not hold Hall 14 Freshmen Orientation Camp Committee 2013/2014, Nanyang Technological University, its officers, agents and employees liable for any damage to or loss of property or any injury or loss of life where such damage to or loss of property or any injury or loss of life is not caused by the negligence of Hall 14 Freshmen Orientation Camp Committee 2013/2014, Nanyang Technological University, its officers, agents and employees. I undertake to ensure strict compliance with all rules, regulations, requirements and instructions related to Hall 14 Freshmen Orientation Camp 2013/2014. I understand that, should I be admitted to Hall 14 Freshmen Orientation Camp 2013/2014 on the basis of any false or inaccurate information declared by me, I may render myself liable to any appropriate action and such false or inaccurate declaration may result in the voidance of any insurance claim arising from or in connection with Hall 14 Freshmen Orientation Camp 2013/2014.

    ______________________________ Name of participant

    ____________________ Signature

    ____________ Date

    Parents or Guardians Undertaking (To be completed if the participant is below the age of 21 years)
    I, being the parent, guardian or person having the care and custody of ______________ (name of participant), do consent that s/he may participate in Hall 14 Freshmen Orientation Camp 2013/2014 and, in consideration of Hall 14 Freshmen Orientation Camp Committee 2013/2014, Nanyang Technological University, its officers, agents and employees permitting him/her to so participate, undertake that I will not, whether on behalf of my child / ward or in my own right, hold Hall 14 Freshmen Orientation Camp Committee 2013/2014, Nanyang Technological University, its officers, agents and employees liable for any damage to or loss of property or any injury or loss of life where such damage to or loss of property or any injury or loss of life is not caused by the negligence of Nanyang Technological University, its officers, agents and employees.

    ________________________________________ Name of parent, guardian/person having the care and custody of the participant

    ____________________ Signature

    __________ Date

    HALL OF RESIDENCE FOURTEEN


    12th Junior Common Room Committee Nanyang Technological University 34 Nanyang Crescent, Singapore 637634 Telephone/Fax: 67950859

    ALCOHOL PROHIBITION FORM (to be signed by participant)


    I acknowledge and agree that participation in Hall 14 Freshmen Orientation Camp 2013/2014 comes with an alcohol prohibition rule during the 5 days of camp from 31/07/2013 04/08/2013. I have full knowledge of this rule and understand that by violating this rule, I may render myself liable to any appropriate action and penalty involved. I undertake to ensure strict compliance with all rules, regulations, requirements and instructions related to Hall 14 Freshmen Orientation Camp 2013/2014.

    ______________________________ Name of participant

    ____________________ Signature

    ____________ Date

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