8/13/2019 Ar Rijal2013 IndemnityForm

1/2

Fityan Assyakirin Youth Unit

Ar-Rijal Cup 2013 Indemnity Form

Participants Particulars please fill up in BLOCK letters)Name NRIC No.

Address____________________________________________________ _____________________________

____________________________________________________ Postal Code: ________________

Contact No: (H) : ________________________

(HP): _________________________

Allergy/Medical History :(please specify)

Age : DOB (dd/mm/yyyy) Gender :

Male / Female

Race :

Email :

Parents / Guardian Contact Number : Hp: (Father/Mother)Declaration Indemnity (Must Be Completed By Parents / Guardians Of Participants below age 21 years old )I, ______________________________________________________ of NRIC No. _________________ ,

*Parent / guardian of ________________________________________________ , *do/do not consent my

*child/ward to participate Ar-Rijal Cup 2013.

I have understood the risk involved in the event and acknowledge that the Ar-Rijal 2013 Committee has takenevery precautionary measure to ensure my childs safety.

I also understand and noted that the Ar-Rijal Cup 2013 Committee will not hold any responsibility for any injur

or mishap that might occur on my *child/ward throughout the programme. I also understand that I am

financially responsible for any medical treatment and/or emergency evacuation resulting from participation in

any activities. In the event my *child/ward is not able to attend the programme indicated above, I understand

that any fees paid will not be refunded.

I hereby certify that the above information given to the organizer is certified true and correct at the time of

submission.

________________________________PARENTS/GUARDIAN SIGNATURE

____________________DATE

8/13/2019 Ar Rijal2013 IndemnityForm

2/2

Fityan Assyakirin Youth Unit

Ar-Rijal Cup 2013 Indemnity Form

Declaration Indemnity (Must Be Completed By Participants 21 years old and above)I, ________________________________________________of NRIC No. _____________________________,

hereby participate the Ar-Rijal Cup 2013 on Saturday, 14 December 2013, understood the risk involved in

participating in the event and that the organiser has taken every precautionary measure to ensure my safety. I d

hereby declare that I waive and release Ar-Rijal 2013 Committee and all who may concern from any loss and/o

damage from of property, loss and/ or injury to my life.

I also understand that I am financially responsible for any medical treatment and/or emergency evacuation

resulting from participation in any activities. In the event I am not able to attend the programme indicated abov

I understand that any fees paid will not be refunded.

I hereby certify that the above information give to the organizer are certified true and correct at the time of

submission.

________________________________PARTICIPANT SIGNATURE

____________________DATE