Registration & Consent Form

Section A: Volunteer’s Particulars1

(As in NRIC / Passport)

Full Name in
Race:
BLOCK Letters:

NRIC / FIN No: Gender: Female / Male

Date of Birth:
Age:
(DD/MM/YYYY)
Height (cm) Weight (kg)

Email Address: Religion:

Home Address:

Home Tel No: Mobile No:

Name of
Employer /
School:
Special Dietary
Requirements Halal / Vegetarian / Others (Pl specify: __________________)
(if any):
MEDICAL BACKGROUND
Have you been or are you currently affected by any of the following? (Please circle)

Diabetes Yes / No Ear Problems Yes / No

Asthma Yes / No Back Problems Yes / No
Low Blood Yes / No Neck Problems Yes / No
High Blood Yes / No Joint Problems Yes / No
Coronary Problems Yes / No Bone Fractures Yes / No
Eye Problems Yes / No Muscle Problems Yes / No
Other condition(s) affecting or restricting you:

Are you on medication / prescribed drugs? Yes / No (Please circle)

If “Yes”, please elaborate:

Had surgery done within the last 2 years? Yes/ No (Please circle)
If “Yes”, please elaborate:

Allergies? Yes/ No (Please circle)

If “Yes”, please state:

1
Please email a passport size photograph to Kelly Low ( kelly.low@touch.org.sg )
Section B: Acknowledgement of Volunteer

I, _______________________________ holder of NRIC/ Passport No: __________________

am aware that my participation in the National Day Parade 2009 with TOUCH Community
Services (TCS) and related training involves certain amount of risks. I understand that I will
have to co-operate fully with the staff and diligently comply with all safety systems. I shall
therefore not hold TCS or their servants and agents responsible for any damage to or loss of
property or any injury or loss of life which may be sustained by myself during the event or
arising from or in connection with the event where such damage to or loss of property or any
injury or loss of life is not caused by the negligence or wilful act or omission of TCS.

Signature: ________________________ Dated: (DD/MM/YYYY)

Section C: Acknowledgement and consent of Parent / Guardian

(For Volunteer below 21 years old)

I, _______________________________ holder of NRIC/ Passport No: __________________

hereby allow my *child/ward, _______________________________ (Full name) to participate
in the National Day Parade 2009 with TOUCH Community Services (TCS).

I am aware that my *child’s/ward’s attendance in the event and related training involves
certain amount of risks. I understand that my *child/ward will have to co-operate fully with the
staff and diligently comply with all safety systems. I shall therefore not hold TCS or their
servants and agents responsible for any damage to or loss of property or any injury or loss of
life which may be sustained by *my child/ward during the event or arising from or in
connection with the event where such damage to or loss of property or any injury or loss of life
is not caused by the negligence or wilful act or omission of TCS.

Signature: ________________________ Dated: (DD/MM/YYYY)

Section D: Contact Person (in the event of emergency)

Name of Contact Person:

Relationship to volunteer:
Contact No:

Address:

*delete where not applicable