Annexe A1- Registration Form for Students

Temasek Foundation International - Science Centre Board STEP STEM ALIVE!

2019 Registration Form for Students
Organised by: Supported by:

COMPLETE ONE FORM PER STUDENT

(Form to be submitted by 1 November 2018)

Given Name: ____________________________________________________________________

Surname: ____________________________________________________________________

*Gender: F / M
*delete where inapplicable

Age: _______________________________________________________

Date of Birth: ____________________________________________________________________

NRIC / Passport No.: _______________________________________________________________

Contact No.: __________________ (Mobile)

__________________ (Home)

Email: ______________________________________________________________________

Secondary Email: _________________________________________________________________

Mailing Address: ____________________________________________________________________

Mailing City, State, Country: __________________________________________________________

Mailing Zip, Postal Code: ______________________________________________________

Name of School/Institution: ______________________________________________

Dietary requirements (eg. Vegetarian, allergy to seafood, etc):

_______________________________________________________________________________

Medical Conditions (if any): ______________________________________________

T-shirt size: ______________________________________________________________

------------------------------------------------Emergency Contact Information-----------------------------------------

Next of Kin Name: ____________________________________________________________

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Address: ____________________________________________________________________

Postal Code: ____________________________________________________________________

Primary Phone: _________________________________________________________________

Alternate Phone: ________________________________________________________________

Relationship: ____________________________________________________________________

Country: ____________________________________________________________________

 I certify that all the information that I have provided is correct.

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 Annexe A2- Indemnity Form for Students

Acknowledgement of Risks and Undertaking

I, [Name of student]_____________________________________, [NRIC/Passport
No.]__________________________ am aware that my participation in some of these activities may
involve certain amount of risks (including but not limited to sustaining personal injuries and/or loss
of life should serious accidents occur).

I undertake to always cooperate with the organiser and to diligently comply with all safety and other
instructions whenever I participate in any of these activities. If I have any safety concerns
whatsoever regarding such activities, I shall inform the organiser to have such concerns addressed
prior to my participation.

I hereby irrevocably undertake that I shall not, to the fullest extent permitted by the laws of
Singapore, hold the organisers, or any of its authorised agents responsible for any damage to or loss
of any personal property of personal injury or death (save for personal injury or death resulting from
the negligence of the organiser or any of its authorised agents) that may arise as a result of my
participation in any activity during the camp.

Signature of student: ______________________________

Date: ________________________

NOTE – if you are under 18, you must also provide your parent’s/ guardian’s details and have
him/her sign the declaration below:

Name of *Parent / Guardian:

*delete where inapplicable

Postal Address: ________________________________________________________________

Telephone number: ________________________________________________________________

NRIC/ Passport no.: _______________________________________________________________

Declaration by Parent / Guardian:

I agree and consent to my child’s / ward’s participation in all the activities organised in this camp,
being fully aware of the attendant risks involved in such activities.

I hereby irrevocably undertake that I shall not, to the fullest extent permitted by the laws of
Singapore, hold the organisers, or any of its authorised agents responsible for any damage to or loss
of any personal property of personal injury or death (save for personal injury or death resulting from
the negligence of the organiser or any of its authorised agents) that may be sustained by my child’s

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/ ward under any of the circumstances set out in my child’s/ ward’s participation in any activity
during the camp.

Signature of Parent / Guardian: ______________________________

Date: ________________________

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