NATIONAL EDUCATION FOUNDATION
PERSONAL INFORMATION FORM
ANNEXURE – III (B)
NAME:
TEAM NAME:
CATEGORY:
Intercollegiate All Girls
Self
Attested
Photograph
ADDRESS:
PH.NOS:
E-MAIL:
___________________________________________________________________
TO BE CONTACTED IN CASE OF EMERGENCY
NAME:.
ADDRESS:
LANDLINE:
MOBILE:
_________________________________________________________________
PERSONAL DETAILS:
OCCUPATION:
EDUCATION:
COLLEGE:
YEAR/COURSE
BIRTH DATE:
M/F:
Male
AGE
HEIGHT:
yrs.
WEIGHT:
BLOOD GROUP:
SIGNATURE & NAME
INSURANCE POLICY NO(compulsory) :
________________
PREVIOUS EXPERIENCE IN SPORTS:
________________
NATIONAL EDUCATION FOUNDATION
DECLARATION BY PARENT / GUARDIAN
ANNEXURE – IV (B)
I,
age
Occupation :
: years,
,residing at.
The father/mother/guardian of Master/Miss
Age:
.Occupation:
residing at
Declare that 1) My son/daughter/ward is participating in K2S-The Monsoon Night Adventure Race 2012 with my permission
and consent, after I have gone through all the Rules and Terms and Conditions formed by the National
Education Foundation (NEF).
2) I declare that I shall not disclose any information relating to any of the terms and conditions, instances,
incident and any other matter taking place during the race and any information obtained by NEF for the purpose
of this Race without, the previous permission in writing from NEF officials, in any manner whatsoever to any
Person / individual/ organization / body corporate / agency etc.
3) I declare that all the decisions taken by the NEF or/and/by the Director or other members, or any other
person authorized by NEF for the purpose of completion of the Race in proper manner or in the interest of my
son/daughter/ward, in the circumstances then prevailing shall be binding on him/her.
4) I declare that after having understood all the Rules and Regulations and Terms and Conditions formed by the
NEF for K2S-The Monsoon Night Adventure Race and after being aware of this risks involved in the Race have
decided to permit my son/daughter/ward to participate in the Race on my own volition, responsibility and without
any coercion or influence by anyone. I shall not hold the NEF or its Director or any other members, or any other
person authorized by the NEF responsible on any count including any injury and/or damage to my
son/daughter/ward or to his/her person or property.
5) I declare that all the necessary information/documents furnished by me and my son/daughter/ward to the
organizers is true and correct to the best of my knowledge, belief and information.
In verification whereof I have signed below this Declaration on this…………day of……….. 2012.
Place:…………………….
Mr/Mrs
Date :……………………...
Father/Mother/Guardian of
Phone No.:
_________________________
Signature of Parent / Guardian
NATIONAL EDUCATION FOUNDATION
DECLARATION BY PARTICIPANT
ANNEXURE – V (B)
I,
. Age
Years, Occupation:
Residing at
declare that,
1) I have gone through all the Rules and Regulations and the Terms And Conditions formed by the National
Education Foundation (NEF) for K2S-The Monsoon Night Adventure Race and have understood the same.
I am also aware that all this Rules and Regulations and the Terms and Conditions are binding on me as a
participant.
2) I declare that,I shall not disclose any information relating to any of the terms and conditions ,instance,
incident and any other matter taking palce during the Race and any information obtained by the NEF for the
purpose of this Race without the previous permission in writing from NEF Officials, in any manner whatsoever
to any person/organization/body agency etc.
3) I declare that all the decisions taken by the NEF or /and by the Director or other members, or any other
person authorized by the NEF for the purpose of completing the Race In proper manner or in the interest of
myself, in the circumstances then prevailing shall be binding on me.
4) I further declare that after having understood all the Rules and Regulations and the Terms and Conditions
formed by the NEF for the Race and after being aware of the risks involved ind the Race I have decided to
participate in the Race on my own volition, responsibility and without any coercion or influence by anyone
including my parents/guardians.
5)
I shall not hold the NEF or its Director or other members or any other person autorised by the NEF
responsible on any count including any injury and/or damage to me/my person or my property.
I declare that all the necessary information/ documents furnished by me to the Organizers are true and
correct to the best of my knowledge, belief and information. ’In verification whereof, I have signed below
this declaration on this ……………………day of ………………….. 2012’.
Place:
Name:………………………….
Date:
Signature:…………………………
Phone No:………………………….
Witness:
Name : ………………………..
Address:…………………………………………..
NATIONAL EDUCATION FOUNDATION
CERTIFICATE OF PHYSICAL FITNESS
ANNEXURE – VI (B)
Name of the doctor: ………………………………………………………………………………………
Qualification: ………………………………………………………………………………………………
This is to certify that I have conducted clinical examination of
Mr. / Mrs. / Miss
Who is desirous of participating in NEF K2S-The Monsoon Night Adventure Race 2012
He has not given any personal history of any disease incapacitating him to undergo the physically
demanding. NEF K2S-The Monsoon Night Adventure Race. Also on clinical examination it has been found
that he is physically fit to undergo the above mentioned Race.
Certified further that he has not shown any evidence of major defects of posture, locomotion, vision, hearing or
any other systemic disorders.
Even though the following deviations have been revealed.
1._________________________________________________________________________
2._________________________________________________________________________
3._________________________________________________________________________
I do not feel that this could hinder his participation in the above mentioned Race on any of the health ground/s.
Signatures:
………………..
PARTICIPANT
…………..
DOCTOR
(STAMP)
……………………………
PARENT/GUARDIAN