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Group Rental Form
Group Rental Form
This form may take you 3 minutes to fill in. You will need the following information to fill in the form: NRIC number or membership card respectively if you are applying under those categories. The workers work permit no. or Foreign Identification Number (FIN) The workers work permit or S pass application date
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ACTIVITY DETAILS
Kayak,single Kayak,double Laser Topper Pico Windsurf Board Double Sit-On-Top Single Sit-On-Top 10-Crew Dragon Boat 20-Crew Dragon Boat Others (please specify)___________________________________
Type of Equipment: (Please indicate the quantity of equipment in box) Rental Time (START):
Organisation/Billing Details
Fax No:
AMOUNT
20-Man Boat :
Group Locker :
Total :
Date Of Payment Receipt Number Payment Mode
Remark :
DECLARATION All applicants in the list below agree abide by the rules and regulations stated and hold themselves solely responsible for any mishap or injury that may occur during, or as a result of their participation, including rental of equipment from the outlet and of equipment from the outlet and certify that they do not have a pre-existing medical condition as declared below. (A copy of the Water-Venture Safety Guidelines is available at the counter) All applicants in the list below declare that all information provided is true and correct; and agree to abide and be bound by the Terms and Conditions of the Community Club Management Committees, other People's Association Organizations; and authorize the People's Association to disclose their personal information to its employees, service providers, vendors and affiliated partners. 1) 2) 3) All users of equipments will have to fill up all details in this section Applicants are to fill up individual rental form with certification by Medical Examiner if any medical condition is ticked Applicants who are under 21 years of age are to indicate if they have obtained permission from their/ parents/guardian to use the equipments
I have obtained permission from my parent/guardian to use the equipment as I am under 21 years of age 1 HAVE YOU EVER HAD (a) Chest pain, high blood pressure, heart problems such as heart murmur, extra heart beat or other heart abnormality (b) Asthma, bronchitis, tuberculosis, sinusitis, other lung problems (c) Fits, epilepsy, fainting attacks, migraine, severe head injury (d) Eye problem/poor vision (e) Ear problem/deafness (f) Nervous illness (g) Diabetes
(b) Special diet 3 DO YOU HAVE (a) Any disability (b) Any other medical information to note, e.g. food, drug allergy
(h) Bone or joint injury (i) A carrier status for any infectious disease (j) Medical treatment within last two years (k) Are you pregnant? 2 DO YOU REQUIRE (a) Routine medication
No.
1
Name
Name / Relationship
Signature/Date
REMARKS (DETAILS FOR ANY MEDICAL CONDITIONS THAT IS TICKED ( A separate form with the certification of fitness should be filled if any of the conditions are ticked)
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