Parent and Guardian Consent Form .pdf

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Parent/Guardian Consent Form (Please FILL in BLOCK LETTERS)
**This form is to be filled in by Parent/Legal Guardian* of participant for participant that aged below 18 years old ONLY.

Lumière 17 - Illumi-Night Run
I,

(Full Name of Parent/Legal Guardian* as in NRIC/Passport*),
(NRIC/Passport*number), the Parent/Legal Guardian* of

______________________________________________ (Full name of Child/Ward* as in NRIC/Passport*),
_____________________________ (NRIC/Passport* u er , here y o se t to y Child/Ward’s* participation in
Lumière 17 – Illumi-Night Run orga ized y Taylor’s U i ersity Co
u ity Ser i e I itiati es C.S.I. Volu teers.
I agree to assu e the risks i ol ed i a d i ide tal to y Child/Ward’s* parti ipatio i Lumière 17 – Illumi-Night
Run as organized by Taylor’s U i ersity Co
u ity Ser i e I itiati es C.S.I. Volu teers. I hereby release and forever
discharge Lumière ’17 – Illumi-Night Run and Taylor’s U i ersity Co
u ity Ser i e I itiati es C.S.I. Volu teers of
and from any losses, accidents, injuries, invalidity and death, all liabilities, claims, actions, damages, costs and
expenses of any nature which may arise out of, or e i a y ay o e ted ith y Child/Ward’s* parti ipatio i
Lumière ’17 – Illumi-Night Run.
I authorise Taylor’s U i ersity Co
u ity Ser i e I itiati es C.S.I. Volu teers to act through any accompanying staff
on duty on my behalf and to make reasonable decisions, in the event where he/she is unable to contact me, which
includes authorisation to dismiss my Child/Ward* from the above event if he/she is found not fit for participation,
dissemination of any personal data and/or sensitive data of my Child/Ward* which is pertinent in any emergency,
and/or for medical attention and/or treatment as recommended by a certified first-aider, physician and/or medical
centres.
I hereby indemnify and hold and save Lumière ’17 – Illumi-Night Run and Taylor’s U i ersity Co
u ity Ser i e
Initiatives (C.S.I.) Volunteers against any and all such liabilities, claims, actions, damages, costs and expenses
i ludi g soli itor’s fees a d dis urse e ts .
Home Address: _______________________________________________________________________________
____________________________________________________________________________________________
Emergency Contact Details: ____________________ (Mobile Phone) ____________________ (Alternate Phone)

_________________________________

_________________________

Signature:

Date:

* Please delete where applicable.

Kindly pass the physical copy of the parent/guardian consent form upon Race Kit Collection. Failure to do so
will result in the rejection of Race Kit collection and disqualification from the race.


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