15th Adventure Camp

ADDITIONAL INFORMATION

GIRIVIHAR

APPLICATION FORM

15th ADVENTURE CAMP 2002

To

The General Secretary,

GIRIVIHAR, Mumbai.

Dear Sir,

My Son/daughter/ward__________________________________________

___________________________________________________________________ desires to participate in the 15th Adventure Camp being organised by GIRIVIHAR from 10th to 16th November 2002 at Kille Sudhagad, Pali (Dist. Raigad.)

 I have read the instructions and assure you that he/she shall abide by the discipline of the camp.

Our family doctor has confirmed his /her medical fitness. He / She is participating in the camp on my own responsibility.

Yours Sincerely,

Parent/Guardian : Signature ____________________________________________

Name :_____________________________________________________________________

Particulars Of The Participant

1.   Name           :___________________________________________________________

2.   Date of Birth          :________________________________          Age :   ___________  years

3.   Address          :___________________________________________________________

                                 _______________________________________________________                                                                                                                                                                                                               _______________________________________________________

4.   e-mail id                         :            ________________________________________________

5.   Telephone No.              : __________________________________________________

                               (Pl. give Cell No., if any)

6.   In case of Emergency contact : ________________________________________

7.   Name of School  : _________________________________________________                        _________________________________________________

8.   Standard                         :      _________________________________________________

9.   Any previous Hiking/Trekking Experience : YES / NO

      (If ‘YES’ please specify)     _________________________________________________

10. Other interests                         : Hobbies / Sports

11. Preferred language of  instructions : English / Hindi / Marathi

12. Parents Occupation                         : Service / Business /

13. Will join the assembly point at                         : Dadar / Thane /

Fees Rs. 1250/- enclosed (By Cash / Cheque / Demand Draft No. ____________ dated ___________ On ___________________________________ Bank) in favour of GIRIVIHAR”.                          (No Money orders please)

Fees handed over to                   :______________________________________

We came to know about this camp through : News paper/School/Friend/

Other  (Pl. specify) ___________________________________________

Note :Camp Charges include Rs. 100/- as Registration Charges  (Non-refundable)