INDEMNITY FORM

Download form here

(In Google Docs, go to File and download)







IMPORTANT:
Students are required to complete and return the form to the group instructor before leaving UPM campus.


INDEMNITY FORM FOR LAX ACTIVITIES
LAX Code & Name: LAX 2015 – Have Food Will Travel
Group No.
List of Group Members Involved
Matric No.
Signature
1.


2.


3.


4.


5.


6.  * Please add more rows as needed.


Destination:

Instructor:


We are aware that if we decide to conduct our LAX activities outside of UPM campus,
we will take full responsibility for any risks, dangers and hazards that may occur including
but not limited to physical injuries and damage or loss of personal property while participating
in the activities.
We have read and understood this agreement.


Name, Matric No. & Contact No. of Group Leader:


…………………………………………………………………………………………………………..
Date:         ……………
                                    
Approved/Received by,                                                           
            
Signature:      ……………………………..                     Date: ……………………………..
                                                         


Instructor’s Name / Official Stamp: …………………………………………………………….……

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