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“Ops Nibu” – 2-Day/1-Night NS aL.I.V.E. Preparatory Camp
                                                                  Ops Nibu
                                                   30th January 2010 – 31st January 2010
                                                   Closing Date: Mon, 22nd January 2010
Personal Particulars
Name (as in NRIC):


Date of Birth & Age:                                NRIC / Passport:                                              Gender:
      /       /                                                                                                   *Male / Female
Residential Address:

                                                                                                                     Postal Code (            )

Tel No(s):                                                               School/Institution/Company Name:
(H)
(M)

Have you been or are you suffering from any physical impairment, disease or illness?            E-mail address:
*Yes / No (If yes, please state.)


*Please delete where applicable.


Declaration
I acknowledge that I am entering these events at my own risk and will not hold the organizers, sponsors, and appointed officials
responsible for any actions, damages, injuries or expenses arising from my participation in this event. I also certify that I am physically fit
to participate in these events.
Name:                                                                     Signature / Date:




(If participant is below 21 years of age, this part is to be completed by the parent/guardian)
I allow my child/ward to participate in these events. I will not hold the organizers, sponsors, and appointed officers responsible for any
actions, damages, injuries or expenses arising from his/her participation in these events.
I hereby sign on the attached list, for my child / ward, in agreement for the above release of liability and assumption of risk.
Name of Parent/Guardian:                                                 Signature / Date:


Contact Number:




                                                            For Official Use Only

Registration No:     __________________                              Total Payment Received:
Official Receipt No: __________________                                                                    ___________________________
                                                                                                           Name of Officer/Mosque Stamp
Remarks:                                                             $___________________
_____________________________________________                                                              ___________________________
_____________________________________________                                                              Signature / Date




                                          Al-Iman Mosque | Ar-Raudhah Mosque | Jamiyah Ar-Rabitah Mosque

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Ops Nibu Form

  • 1. “Ops Nibu” – 2-Day/1-Night NS aL.I.V.E. Preparatory Camp Ops Nibu 30th January 2010 – 31st January 2010 Closing Date: Mon, 22nd January 2010 Personal Particulars Name (as in NRIC): Date of Birth & Age: NRIC / Passport: Gender: / / *Male / Female Residential Address: Postal Code ( ) Tel No(s): School/Institution/Company Name: (H) (M) Have you been or are you suffering from any physical impairment, disease or illness? E-mail address: *Yes / No (If yes, please state.) *Please delete where applicable. Declaration I acknowledge that I am entering these events at my own risk and will not hold the organizers, sponsors, and appointed officials responsible for any actions, damages, injuries or expenses arising from my participation in this event. I also certify that I am physically fit to participate in these events. Name: Signature / Date: (If participant is below 21 years of age, this part is to be completed by the parent/guardian) I allow my child/ward to participate in these events. I will not hold the organizers, sponsors, and appointed officers responsible for any actions, damages, injuries or expenses arising from his/her participation in these events. I hereby sign on the attached list, for my child / ward, in agreement for the above release of liability and assumption of risk. Name of Parent/Guardian: Signature / Date: Contact Number: For Official Use Only Registration No: __________________ Total Payment Received: Official Receipt No: __________________ ___________________________ Name of Officer/Mosque Stamp Remarks: $___________________ _____________________________________________ ___________________________ _____________________________________________ Signature / Date Al-Iman Mosque | Ar-Raudhah Mosque | Jamiyah Ar-Rabitah Mosque