Registration & Indemnity Release Form
(to be filled by all participants & organisers joining the expedition convoy)
Tour Name : ………………………………
Tour Date : .......................
Name As in I.C : ............................................................
I.D. No. .....................
Address : ....................................................................
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Phone: ……………….. Hand Phone: …………………. Email: ………………….
My Role in This Program is : * Participant / Coordinator & Organiser
Date of Birth : ................... Age : .................... Sex : .....
Blood Type : ................... Height : ....................
Weight : ...................
Please State Any Medical Conditions or Allergies that may require special attention
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Name tel no. & Address of Next Of Kin to be contacted in case of emergencies
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Indemnity Release Statement by the above named participant
/ coordinator
I, the above named person a participant/organiser participating in the
said Adventure program understand that it is a form of adventure
sports event that is set to take place in a harsh outdoor environment and
I confirm that I am fully aware, understand and agree that being such type
of event there are inherent dangers & certain elements
unpredictability that accompany the excitement. As such, I agree to
indemnify and keep indemnied Mudtreker from any claims whatsoever and
agree that I shall not hold Mudtrekker and its employers owner/s employees
agents servants responsible nor be held liable for any personal injury,
mental anguish, loss of any kind whatsoever howsoever caused that may
occur during the event. And further agree to abide by all instructions
issued by the facilitators/organisers of this event |
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(Signature)
Date .........................
* Please strike out whichever not applicable
** The complete form must be submitted before Adventure commences.
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