PENANG AMATEUR SWIMMING ASSOCIATION

c/o Kompleks Sukan MBPP, Lebuh Relau, Relau

11900 Bayan Lepas, PULAU PINANG
Email: honsec.pasa@yahoo.com

CHEE CHEE SIONG

Name: ……………………………………………
30, Gerbang Sungai Ara 2
Address: ……………………..…………………..
Taman Pagar Buluh, 11900 Bayan Lepas, Pulau Pinang
…………………………………………………….

To,
Penang Amateur Swimming Association

Declaration Form
Chee Shi Hui
I, _________________________________________, 110204070236
NRIC / Mykid ____________________

wish to take part in the following:

Event: 59th MILO/MAS MALAYSIA INVITATIONAL AGE GROUP SWIMMING

CHAMPIONSHIPS 2024

Date: 25th – 28TH APRIL 2024

Venue: NATIONAL AQUATIC CENTER, KLSC BUKIT JALIL

I agree to abide by the rules and regulations given to me while, during and after the overseas training
programme by the organiser, and / or team officials assigned by Penang Amateur Swimming
Association, or its assignees and agents.

I hereby declare that I am physically and mentally fit and that I have no disabilities,
impairments or ailments preventing me from engaging in active or passive exercise that will be
detrimental to heart, safety, or comfort, and / or physical condition if I participate in the above
mentioned.

I understand that the organiser, and / or team officials assigned by Penang Amateur Swimming
Association, or its assignees and agents shall not be liable for any damages arising from personal
injuries sustained by me while, during or after the Championships. I assume full responsibility for any
injuries and / or damages which may occur while, during or after the Championships.

I hereby for myself, my heirs, executors and administrators, waive fully and forever release and
discharge the organiser, or team officials assigned by Penang Amateur Swimming Association, or its
assignees and agents from all rights of claims, demands, damages, unexpected accidents, rights of
action, present and future therein.

I have read and understood the foregoing information.

Signature: Witness:

Name of participant: CHEE SHI HUI Name: WANNA

Date: 15-3-2023 Date: 15-3-2024

 Parents’ Consent Declaration

CHEE CHEE SIONG

I, ……………………………………………………………………(name of parents / Guardian),

780815075493
NRIC: ………………………… CHEE SHI HUI
hereby given my ** son / daughter………………………………………….
110204070236
NRIC: …………….……………… to participate in the event below:

Event: 59th MILO/MAS MALAYSIA INVITATIONAL AGE GROUP SWIMMING

CHAMPIONSHIPS 2024

Date: 25th – 28TH APRIL 2024

Venue: NATIONAL AQUATIC CENTER, KLSC BUKIT JALIL

Parent’s signature:

Name: CHEE CHEE SIONG

Date: 15-3-2024

Witness:

Name: Wanna

Date: 15-3-2024