Indemnity Form (Sports For Life)
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1INDEMNITY FORM
(Sports for Life)
Name of Activity:
Activity Dates:
Sports for Life Programme
Start Date: _________
End Date: _________
Venue/Location:
Programme Coordinator:
___________________
Ms Sally Lim
I,
(
),
(NAME, parent/ guardian*)_____________________
NRIC No/ PPT No
give consent to and declare that my child/ward*,_________________________________ (
),
NAME
____________________(
) is FIT to participate in the above activity conducted by Singapore
NRIC No/ PPT No
Polytechnic, its servants and organisers.
TERMS AND CONDITIONS
1. All students are advised to undergo a medical examination prior to the start of the
programme/training/activity/camp. All students must be medically, mentally and physically able to
participate in the programme/training/activity/camp throughout the entire duration of their
involvement.
2. All students acknowledge that some of the activities may involve a significant degree of physical
exertion and physical risk.
3. All students should ONLY participate when there is a qualified instructor/appointed personnel
supervising the programmes/trainings/activities/camps.
4. Singapore Polytechnic will not be held responsible for any personal injury, death, and/ or any other
consequential
misfortune/accident/loss/damage
that
may
arise
in
the
course
of
the
programmes/trainings/activities/camps.
I have read and understood the above terms and conditions. I am aware of the possible risks involved and
accept the same. I confirm that I am enrolling my child/ward* on my own volition and shall not hold the
Singapore Polytechnic, its servants and organisers responsible or in any way liable for my child/ward* personal
injury, death, and/or any other consequential misfortune/accident/loss/damage whatsoever arising from any
cause in connection with the programmes/trainings/activities/camps.
I grant my consent for our personal particulars to be given by Singapore Polytechnic to the relevant
authorities/parties, for example, Ministry of Education, Ministry of Foreign Affairs, Ministry of Defence
(MINDEF) etc. to facilitate programme execution, travel notices and for emergencies purposes etc.
Parent/ Guardian* Signature:
Student Signature:
Parent/ Guardian* Contact No:
Student Name:
Parent/ Guardian* Email:
Student Admin Number: __________________
Date:
Date: _____________
DSD-FRM-140B
SP Indemnity Form (Sports for Life)
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