FACULTY OF RESOURCE SCIENCE & TECHNOLOGY

UNIVERSITI MALAYSIA SARAWAK

RELEASE OF LIABILITIES
READ CAREFULLY - THIS AFFECTS YOUR LEGAL RIGHTS

In exchange of participation in the Activity/ Trip mentioned below,

Name Activity/ Trip :
Organiser :
Date/s : (DD/MM/YYYY)/ (DD/MM/YYYY)
Duration (Hours/ Days):
Place/s :

I ____________________________________, MyKad/ Passport No : __________________,

agree to observe and fully comply with all the rules and regulations as imposed upon me.
I am responsible for the safety of my own self while participating in the activities conducted
(in/outside the University grounds) and I am responsible for any incidents which may occur to
myself, due to my own negligence and would not blame and / or bring a lawsuit against
Universiti Malaysia Sarawak if any incidents occur during the abovementioned activity.
I am also responsible to inform my involvement in the abovementioned activity to my parents
or guardians.
I HAVE READ THIS DOCUMENT AND UNDERSTOOD IT. I FURTHER
UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY
SURRENDER CERTAIN LEGAL RIGHTS.

Confirmation by the participant Confirmation by the Faculty

_________________________________ _________________________________
Signature Signature (HoD/ Dean)

Name : Name :
MyKad/Passport No.: Official Stamp:
Mobile Contact: Date:
Date:

Emergency Contact:
In case of emergency, please call : ______________________
Relationship to participant : ___________________