(Q2 + Q3 2019) Assumption of Risk and Release of Liability Form (below 18)

THE FUN EMPIRE

WAIVER AND RELEASE OF LIABILITY

You are required to read and complete this form before you and/or your child/ward participates in any of our activities.

By submiting this form, you also acknowledge that you have read and agree to our Data Protection Policy.

Event ID

Group Pax

Activity Type*

Event Date *

Date

Time

:HourMinutesAM/PM Option

Event Location *

PARENT/GUARDIAN'S INFORMATION

Adult's Full Name*

First NameLast Name

Adult's Date of Birth*

Date

Adult's NRIC / FIN / Passport Number (Last 3 digits + checksum. Example 123D)*

Adult's E-mail*

example@example.com

Adult's Phone Number*

CHILD 1 INFORMATION

Child 1's Full Name*

First NameLast Name

Child 1's Date of Birth*

Date

Child 1's NRIC / FIN / Passport Number (Last 3 digits + checksum. Example 123D)*

Add Another Child?*

YesNo

CHILD 2 INFORMATION

Child 2's Full Name

First NameLast Name

Child 2's Date of Birth

Date

Child 2's NRIC / FIN / Passport Number (Last 3 digits + checksum. Example 123D)

Add Another Child?

YesNo

CHILD 3 INFORMATION

Child 3's Full Name

First NameLast Name

Child 3's Date of Birth

Date

Child 3's NRIC / FIN / Passport Number (Last 3 digits + checksum. Example 123D)

Add Another Child?

YesNo

CHILD 4 INFORMATION

Child 4's Full Name

First NameLast Name

Child 4's Date of Birth

Date

Child 4's NRIC / FIN / Passport Number (Last 3 digits + checksum. Example 123D)

Add Another Child?

YesNo

CHILD 5 INFORMATION

Child 5's Full Name

First NameLast Name

Child 5's Date of Birth

Date

Child 5's NRIC / FIN / Passport Number (Last 3 digits + checksum. Example 123D)

Form Submission Date

Date