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Indemnity Form: Please Bring This Form Duly Completed With You When You Check in For The Event

Students under 18 must have their parent/guardian complete an indemnity form to participate in a mathematics and statistics orientation camp from July 13-15, 2019. The form absolves and discharges the university from responsibility for any loss or damage arising from negligent acts during the event. It also requires participants to indemnify and hold the university harmless against any claims or expenses resulting from participation in the orientation camp. Participants must sign and date the form in the presence of a witness.

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265 views1 page

Indemnity Form: Please Bring This Form Duly Completed With You When You Check in For The Event

Students under 18 must have their parent/guardian complete an indemnity form to participate in a mathematics and statistics orientation camp from July 13-15, 2019. The form absolves and discharges the university from responsibility for any loss or damage arising from negligent acts during the event. It also requires participants to indemnify and hold the university harmless against any claims or expenses resulting from participation in the orientation camp. Participants must sign and date the form in the presence of a witness.

Uploaded by

dipasukha
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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Students who are below 18 years old are required to have their parent/legal guardian complete this form.

Students
who are above 18 years old have to acknowledge by signing this indemnity form.

Indemnity Form

Please bring this form duly completed with you when you check in for the Event –
<Name of Event>
I, _________________________________ (Name of student/parent/guardian, as applicable)
________________________________ (Passport or NRIC No.), *parent/guardian of
_________________________________ (Name of student) ________________ (Passport or
NRIC No.), hereby declare that *I/my *child/ward *am/is participating in the Mathematics and
Statistics Orientation Camp 2019 , [including the trip to Faculty of Science (LT26),] on 13 July 2019
– 15 July 2019 of *my/his/her own free will and volition, *am/is aware of the risks involved and in
consideration of being permitted by NUS Mathematics Society and NUS Statistics Society,
National University of Singapore (“NUS”) to participate in the Event, I, for myself *and my
*child/ward, my successors, personal representatives and assigns:

(a) do hereby absolve, acquit and discharge NUS (which shall include its officers, servants,
employees, agents or volunteers) from all or any responsibility, actions, causes of action,
claims, demands and obligations arising from any loss or damage (to the extent
permissible by law), arising from NUS’ negligent acts or omissions sustained *my/my
*child/ward’s participation in the Event; and

(b) will indemnify save and hold harmless NUS (which shall include its officers, servants,
employees, agents or volunteers as well as any third parties thererto) against all losses,
claims, demands, actions, proceedings – damages, costs or expenses (including legal
fees) arising from my/my *child/ward’s participation in the Event.

_________________________________ _________________________
Signature Date

In the presence of:

_________________________________ _________________________
Signature of Witness Name & Passport/NRIC No. of
Witness
*Please delete accordingly.
EM Division, OSHE
Correct as at 19 Jun 2017

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