(For Office Use Only)

To
The Faculty Advisor
Himalayan Explorers` Club
IIT Roorkee, Roorkee

I hereby agree to adhere to, and respect the terms mentioned in the Sections I, II, III and IV pertaining to my
participation in events organized by HEC[1]. I fully understand that these are student-organized activities and I
hold myself responsible for all my actions and their consequences. I shall not hold Himalayan Explorers’ Club,
IIT Roorkee responsible for any loss or injury. I hold myself liable for strict disciplinary action in case of any
misconduct.

Name of the undersigned: ______________

Date: ______________
Attested Photo
Place: ______________ of the Student
Signature: ______________

Enrolment No: ______________

Mobile: ______________

Email: _____________________________
 PARENT’S / GUARDIAN’S CONSENT

I hereby consent the participation of my ward in various outstation activities and adventure sports as listed
below and organized by the HEC, IIT Roorkee. I acknowledge that the activities are bound by terms
mentioned in the Sections I, II, III and IV. I understand that such expeditions are organized by student
groups themselves and HEC, IIT Roorkee is only a facilitator. I shall not hold IIT Roorkee responsible in
the event of any loss or injury to my ward, and respect the disciplinary actions taken against my ward in
situation of misconduct[2].

List of Activities[3]:
Long & Short Treks
Rangering Expeditions Attested Photo
Paragliding Attested Photo
of the
Rafting & Camping of the Student
Parent/Guardian
Rock Climbing & Training
Confidence Assault Training
Cycle Race

Signature: : ___________________

Name: ___________________

Relationship: ___________________

Date: ___________________

Place: ___________________

Full Address: ___________________________________

Mobile: Father- _____________ Mother- _____________

Annexure I: Definitions

[1] HEC ( Noun, abbr.) :

Himalayan Explorers’ Club. Institute recognized student body under DoSW[a], IIT Roorkee responsible
for undertaking adventure activities and sports in and outside the campus.

Address: Multi Activity Centre, IIT Roorkee, 247667, Uttarakhand

[2] Misconduct:

 Disobeying the instructions of the in-charge HEC member(s)

 Intentionally destroying/vandalizing/stealing the property[b] of HEC
 Misbehaving physically/verbally of any kind with in-charge HEC members(s)
 Misbehaving/quarrelling/unhealthy competence with fellow trek members
 Forging of official documents like Consent Form, Medical Certificate, Attendance Lists etc

[3] Activities (non-exhaustive):

 Long and Short Treks

 Rangering and Rovering
 Rafting
 Paragliding
 Cycle-race
 Skating
 Plantation Drive
 Confidence Assault Training
 Guest Lectures

[a] DoSW (Noun, abbr.): Dean of Students’ Welfare, IIT Roorkee

[b] Property:

Tents, sleeping bags, mats, gas stove, cylinder, torches, or any other utilities purchased or rented at the
expense of HEC.

______________________ ______________________

Parent’s Signature Student’s Signature

Annexure II:
Section 1: Refunding of Registration Fee
 The registration fee (and/or trek fee) is non-refundable under all circumstances, except:
o Cancellation of trek, prior to starting.
o Unforeseen mishaps (God forbid) within the student’s household.
o Disease/Injury that renders the students unfit for the activity, justified by a valid medical
certificate.
o Revision in dates of important events like, but not limited to, examinations,
placement/internship interviews and tests, inter-college competitions, post registration and
occurring within the span of the trek.

Section 2: Registration and Shortlisting for the Trek

 The registration for each trek will be on first-come-first-served basis.

 The shortlisting of final students going for the trek will be done solely on the basis of the criteria devised
by the trek leader.
 The trek leader will have the final say in all matters of scrutinizing and finalizing the shortlist.
 The size of the contingent will be limited by the availability of seats, type of trek and trekking
resources.

Section 3: Disciplinary Action in Case of Misconduct

 In case of misconduct, the student is liable for suitable following (but not limited to) strict
disciplinary action, as considered appropriate by the Faculty Advisor HEC and DoSW IITR:
o Monetary Fine
o Debarment from any activity organized by HEC
o Shramdaan
o Trial in front of the Institute Disciplinary Committee

Section 4: Validity of the Consent Form

 The students are required to submit the original consent form, duly attested by self and
parents/guardian.
 The consent form needs to be submitted only once and stands valid for one academic year.

______________________ ______________________

Parent’s Signature Student’s Signature