Borang Penyertaan

ECO KID ADVENTURE

* excluding transport.
 

 

 

 

Maklumat Peserta

Nama:
E-mail:
No. Telefon:
No. Fax.:
Umur:
Tarikh Lahir:
Jantina:
Warganegara:
No. Surat Beranak / Kad Pengenalan:
Alamat Surat Menyurat:

Maklumat Ibubapa / Penjaga

Nama Ibu / bapa/ Penjaga :
No. Kad Pengenalan:
No. Telefon Bimbit:
No. Telefon Pejabat:
No. Fax.:
Pekerjaan:
Minat dan pengalaman anak anda
Nota

Maklumat Kesihatan Peserta

Sila baca dengan teliti dan jawab dengan jujur mengenai keadaan kesihatan anak anda.
Sebarang penyakit yang memerlukan perhatian tambahan?
Mengambil ubat secara berkala ataupun alahan kepada makanan atau minuman?
Pernahkah anak anda menghadiri sebarang aktiviti perkhemahan sebelum ini?
Kemahiran tertentu. eg.Pertolongan cemas atau lain-lain ?

Lokasi: Tarikh Pilihan:

Other Needs

Parents Declaration & Agreement

I/we the parent and/or legal guardian of name of child understands that the above registration involves the following commitment to our part: The total fees for all the designated summer camp program, food & beverages,lodging, facilitators,instructors and course materials for the Summer Camp amounting to RM shall be deposited into the account of ECO KID ADVENTURE, BANK PERTANIAN MALAYSIA. A/C NO 10310003181 - seven (7) working days before the date of the camp program. I/we believe that my/our child is qualified for camp life and hereby give full permission for my/our child/children to take part in all the indoor and outdoor activities organized by Eco Kid Adventure and also agree to place him/her in the care of the camp, subjected to its rules and regulation.In any case of an emergency, that involve the participant from the nearest available qualified medical practitoner, clinic or hospital. In case of medical emergency that need immediate surgery we hereby authorized and given permission to the physician selected by the Camp Director to hospitalise, order injection, anaesthetic and perform emergency surgery. I/we also agree that in case of any misconduct of my child/children, that could endanger other participants, Eco Kid Adventure or its authorized agents have the right to decide on the possibility of sending the my/our child/children home at our own cost.

Date : Cheque No :

Agree : Yes No

 Payment  Details 
Cheque Payable to: 
ECO KID ADVENTURE or into BANK PERTANIAN MALAYSIA. (A/C NO 10310003181)

Please send/fax/call us (012-6710968) a copy of the bank-in slip once you bank in to our account as proof of payment
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