DBS Sailing at the Bay indemnity form - Singapore Sailing Federation

Email*

First name (as in NRIC/FIN or Passport)*

Last name (as in NRIC/FIN or Passport)*

Are you between 7 and 70 years old?*

I am a …. (Please select ONE of the following)*

Date of Birth - you must be between 7 to 70 years old to participate*

Gender*

Mobile Phone number*

Organisation

Medical Declaration & History*

Are you currently on any medication?*

Do you have any allergies?*

Do you have record of past injuries?*

What is the name of your emergency contact person?*

What is your relationship with your emergency contact?*

What is the contact number of your emergency contact?*

Indemnity Declaration*

By submitting this form, I/my child/ward am/is participating in the DBS Sailing at the Bay Programme (the “Programme”) organized by DBS Bank Ltd in partnership with the Singapore Sailing Federation (the “Organisers”). By participating in the Programme, I confirm that I/my child/ward is doing so on *my/his/her own free will and volition and I am aware of the risks involved. I accept that the Organisers shall be relying on the answers set out in this form, in particular, the medical history portion and confirm that the answers given above are accurate and not misleading. In consideration of being permitted by the Organisers to participate in the Programme, I: (a) do hereby absolve, acquit and discharge the Organisers (including its officers, servants, employees, agents or volunteers) from all or any responsibility, actions, causes of action, claims, demands and obligations whatsoever arising from any loss or damage, to the extent permissible by law, (including, without limitation physical injury, loss of life or property damage) caused by or sustained as a result of *my/my*child/ward’s participation in the Programme; (b) shall be fully responsible for any loss, damage (including, without limitation physical injury, loss of life or property damage) caused by or sustained as a result of *my/my *child/ward’s participation in the Programme where the answers given in this form were inaccurate or misleading; and (c) will indemnify and keep indemnified, save and hold harmless the Organisers (including its officers, servants, employees, agents or volunteers) against all losses, claims, demands, actions, proceedings, damages, costs or expenses, including legal fees, and any other liability arising in any way from my/my *child/ward’s participation in the Programme. (d) consent to the Organisers collecting and using my personal particulars (including but not limited to name and contact details) for purposes of the DBS Sailing at the Bay Programme.

Yes