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    MITWPU Nisargvedh Declaration Form

    Uploaded by

    rikkeyvats

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    MITWPU Nisargvedh Declaration Form

    Uploaded by

    rikkeyvats
    2 views1 page

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    2 views1 page

    MITWPU Nisargvedh Declaration Form

    Uploaded by

    rikkeyvats

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    GIRIPREMI ADVENTURE FOUNDATION

    1294,Shivajinagar, Pune 411005


    Phn No: 7387773655 / 8975398886

    ENROLLMENT FORM

    Name of the participant

    Residential Address

    Trek Location
    Contact Number
    (Parent’s no in case of E mail
    minor)
    Date of Birth Gender

    Fitness Declaration (to be signed by parent / guardian in case of minor participants)

    I understand the nature of the Outdoor / Adventure program I am / my ward is going to attend, and I declare that I
    don’t / my ward doesn’t have any medical prohibition to participate in this activity. In case of any illness / ailment /
    injury which may restrict me / my ward from taking part in some of the activities, I shall inform the same to
    organizers before the activity and keep away from such activity.

    Indemnity / Waiver (to be signed by parent / guardian in case of minor participants)

    1) I declare that, I am / my ward is participating voluntarily in the outdoor intervention / adventure activity /
    trek planned by Giripremi Adventure Foundation, knowing all the probable risks and dangers involved in such
    kind of activities. I understand that the program will be conducted with ample safety precautions and I will not
    hold the Organization or the Organizers / office bearers / staff responsible for any accident / mishap, which may
    occur during the program / activity / trek.

    2) I also understand that in case of any medical emergencies, family consent may be required for the medical
    treatment. I therefore authorize the organizers of the program to consent to any medical treatment, which a
    medical practitioner deems necessary.

    3) I understand that Insurance cover is advisable in such activities and I shall obtain the same before activity.
    In case I am not able to obtain the insurance cover, I will not hold organizers responsible for the same.

    4) I also understand that this indemnity / waiver are valid for all the programs / activities / treks organized by
    Giripremi Adventure Foundation that I / my ward may participate into.

    Signature Participant / Parent / Guardian:

    Name of Participant / Parent / Guardian: Date:

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