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