Indemnity Form

PEOPLES ASSOCIATION YOUTH MOVEMENT SANDSATIONAL RACE 2009 INDEMNITY FORM

Name of Team: __________________________________________________________ IMPORTANT NOTES 1. All participants MUST complete this form and submit it together with the registration form. 2. Participants who are below 16 years of age as at 1 January 2009 (Pls change accordingly to registration closing date for others) MUST obtain parental consent to take part in the race. (Participant’s parent/guardian must complete part B). A TO BE COMPLETED BY INDIVIDUAL PARTICIPANT I, (Name) _________________________________, (NRIC No.) ______________________ (Address) _____________________________________________________________________________________ am aware that my participation in the race involves certain amount of risks. I declare that I am physically fit to meet the challenges which the tournament demands. I further declare that I take part in this race with full knowledge of the consequences which may arise during the period of the race and I shall therefore not hold the Organisers nor the People’s Association or their servants and agents responsible for any damage to or loss of property or any injury or loss of life which may be sustained by me during the race or arising from any cause in connection with the race where such damage to or loss of property or any injury or loss of life is not caused by the negligence or wilful act or omission of the Organisers or the People’s Association or their servants and agents. I agree to allow the People’s Association to disclose my personal information to its service providers, vendors as it is necessary for official purpose in connection with the race and the People’s Association. My email is: _________________________________________ I *am/am not a PAssion Card Member. In case of emergency, please contact: (Name) ______________________ (Contact No.) _____________

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Signature of Participant

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Date

B TO BE COMPLETED BY PARENT/GUARDIAN OF PARTICIPANT WHO IS BELOW 16 YEARS OLD I, (Name) ________________________, (NRIC No.) _______________ (Contact No.) ________________ allow my child/ward as mentioned above to take part in the above race. I am aware that my child’s/ward’s participation in the above mentioned event involves certain amount of risks. I shall therefore not hold the Organisers nor the People’s Association or their servants and agents responsible for any damage to or loss of property or any injury or loss of life which may be sustained by my child/ward during the race or arising from any cause in connection with the race where such damage to or loss of property or any injury or loss of life is not caused by the negligence or wilful act or omission of the Organisers or the People’s Association or their servants and agents.

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Signature of Parent / Guardian

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Date