Name of Program: Adventure Camp Venue: Mahal (Dang)

Date: 11 12th June 2017

th

Application Form

Note following points before you apply:

1. Trekking programs are tough. It is not like picnics or sightseeing tours.
2. Apply only if you are ready to stretch yourself.
3. Be prepared to face some hardships, Physical and Mental stretching & discomfort.
4. Be prepared for Excitement, Adventure & Tough tasks. Be ready for Forced & Self discipline.
5. Consumption of Alcohol in any form or carrying it is prohibited / not allowed during the
program.
6. Market visit / Tourist place visits are not allowed during the program unless it is a part of
training assignment / activity.

Full Name of Applicant ________________________________________________________________

Date of Birth: ___________Height: _________Weight: _______ Blood Group: _______ Male / Female

Name of College / Institute / Organisation: ________________________________________________

Course / Department: _________________________ Year / Designation: _______________________

Residential Address: __________________________________________________________________

___________________________________________________________________________________

City: ___________________ Pin Code: _____________________ Mobile: ______________________

E mail id: _____________________________________________ Phone(R): ____________________

Mention if you have any experience of trekking / rock climbing / adventurous course:

1._________________________________________ 2. _____________________________________

Are you physically & mentally fit to undergo such adventurous training? YES / NO

Date: _______________ Signature of Applicant: ____________________________________________

 Acknowledgement of Danger and Release from Liability

I the under signed, intend to join this Adventure program at my own Will, cost and risk. I know that
this type of training requires tremendous commitment and discipline both physically and mentally, I
also know that it involves life threatening risks and in that case I or my family will not hold the
Organizers, Coaching team members and staff of totheidea responsible. I also undertake to abide by
the rules and regulations for the course, failing to which may result in my expulsion from the program.
The above information is true to the best of my knowledge and belief.

Date: _______________ Signature of applicant: ____________________________________________

Acknowledgement of Danger and Release from Liability

(To be filled and signed by Parents / Event - Program In-charge)

I the undersigned, namely _____________________________________________________________

Designation __________________ Name of Organisation ____________________________________

hereby give consent to my son / daughter / ward / member to join and undergo this Adventure
Program at place and period mentioned in the Application Form. I am fully aware of the dangers
involved during this kind of training program and if my son / daughter / member meets with an
accident fatal or otherwise during the entire program, I shall not hold the Organizers, Coaching
team members and staff of totheidea responsible for the same. I also agree and accept that my
member has to and will abide by the rules and regulation of the course, failing to which may result in
his/her expulsion from the program without notice.

Date: _______________ Signature: ____________________________________