SPARK Leadership Camp 2018 (Public Auditions)

SPARK AUDITIONS 2019 REGISTRATION

Your leadership journey begins here!

PARENT PARTICULARS
Parent's Name*

First NameMiddle NameLast Name
Parent's Contact Number*
XXX - XXXXXXX
Parent's NRIC*
XXXXXX - XX - XXXX
Parent's Email*
example@example.com

PARTICIPANT PARTICULARS
Participant's Name (As per IC)*

First NameLast Name
Participant's Age*
Gender*

MaleFemale
Participant's NRIC*
XXXXXX - XX - XXXX
Participant's Email*
example@example.com
Participant's Contact Number*
XXX - XXXXXXX
Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
School*
Dietary Restrictions*
e.g. No Pork / No Beef
Medical Conditions / Allergies*
e.g. seafood, peanuts, etc.
In 500 words or less, tell us : With all the negative headlines dominating the news these days,it can be difficult to spot signs of progress. WHAT MAKES YOU OPTIMISTIC ABOUT THE FUTURE?*
Are you a Leaderonomics Club member?*

YesNo

By signing below, I/we (Parent/Guardian of Participant and Participant) agree to the following terms and conditions of participating in the SPARK Leadership Programme Public Auditions (“the Programme”) organised by Leaderonomics Sdn. Bhd., in partnership with ECM Libra Foundation and Epsom College Malaysia (collectively known as “the Organisers”) taking place on 20th July 2019.

AVAILABILITY & WITHDRAWAL POLICY

If shortlisted, I/we certify the Participant’s availability on 20th July 2019 to participate in the entire duration of the Programme. If for any reason the Participant must withdraw from the Programme, I/we must inform Leaderonomics Sdn. Bhd. of such withdrawal by 13th July 2019.

MEDICAL CONDITION & AUTHORISATION

I certify that the named Participant is physically able to participate in the SPARK Leadership Programme and that I know of no restrictions, physical impairments, or any other facts, which in any manner limit his/her participation in such a programme. I also understand that the Organisers will administer no physical examinations and that the Organisers will rely solely upon the information shown on this form. I give permission for Participant to receive emergency medical or surgical treatment and hospitalisation if necessary. I hereby authorise staff, coordinators and facilitators of the Programme to act on my behalf according to their best judgment in any emergency requiring medical or surgical treatment and hospitalisation if necessary.

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FINANCIAL RESPONSIBILITY & INSURANCE

I will be financially responsible for any medical attention needed during the Programme or resulting from an injury received at the Programme. I also understand and agree that the Organisers shall not assume, or be responsible or liable for expense, medical treatment, or compensation for any injury to the named Participant may suffer during the Programme participation or related activities.

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COMPLIANCE WITH PROGRAMME RULES

The Participant understands and agrees to comply with all programme rules, policies, and stated and customary terms, conditions or requirements for participation, including any rules or conditions of any accommodation or transportation service provider which the Participant uses during the programme.

I agree that if you observe any unusual or significant concern in Participant’s readiness for participation in the programme or Participant’s failure or unwillingness to comply with the programme rules, Leaderonomics staff and Camp coordinators may, at their sole discretion, remove participant from participation.

Also, I hereby release and forever discharge Leaderonomics from any and all claims, actions, damages, or liabilities (including legal fees and costs), arising from or related to any acts, actions, failures to act by Participant or Participant's disregard or failure to follow Camp rules.

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ASSUMPTION OF RISK OF PROGRAMME ACTIVITIES

I understand the risk of injury to Participant from the activities involved in the SPARK Leadership Programme, even if staff, coordinators and facilitators of the Programme take every practical precaution to ensure the safety of participants. The term “Programme Activities” includes but is not limited to: travel to and from the Programme, and activities during the Programme. I/we knowingly and freely assume all such risks, and I/we assume full responsibility for participation in the Programme by the Participant.

PUBLICITY

I understand and agree for Leaderonomics to hold the right to use, for publicity and advertising, photographs and videos of participants taken at the Camp.
Parent's/Guardian's Understanding of Terms
I have read these camp terms & conditions and waiver & release of liability, and fully understand its terms, and indicate my agreement freely and voluntarily without any inducement.*

Yes, I Agree

For any other inquiries, email to us at spark@leaderonomics.com or call us at 03-7957 5809.

We will be more than happy to help you to understand our work here in building this nation through the development of the youths in Malaysia.

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SPARK AUDITIONS 2019 REGISTRATION