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K2 s form_final

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K2S The inter-collegiate night adventure race on 29th, 30th July 2011

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K2 s form_final

  1. 1. NATIONAL EDUCATION FOUNDATION 25,Parvati, Purandare Building, Pune. Tel.: 020- 24428359 Visit us at: www.enduro3.com ENTRY FORM FORM SHOULD BE IN BLOCK LETTERS &TYPED FORMAT ONLY ANNEXURE – ITEAM CATEGORY: ………………………………………………………………………...TEAM NAME: ……………………………………………………………………………….. (FOR OFFICE USE ONLY)NAME OF COLLEGE: ………………………………………………………………………………………ADDRESS OF COLLEGE………………………………………………….……………. A__________________________________________________________________ Self AttestedA Team Leader: ………………………………………………………………………… Photograph AGE: ……… M/F T-SHIRT SIZE: S / M / L / XL/ XXL BIRTH DATE: …………………………PHONE NO.: ……………………………… BLOOD GROUP: …….. EMAIL ID………………………………………………….__________________________________________________________________ BB NAME………………………………………………………………………………… Self Attested AGE: ……… M/F T-SHIRT SIZE: S / M / L / XL/ XXL Photograph BIRTH DATE: …………………………PHONE NO: ………………………. BLOOD GROUP: …….. EMAIL ID:………………………………………………….__________________________________________________________________C NAME…………………………………………………………………………………. C AGE: ……… M/F T-SHIRT SIZE: S / M / L / XL/ XXL Self Attested Photograph BIRTH DATE: ………………………… PHONE NO: ……………………………. BLOOD GROUP: ……… EMAIL ID………………………………………………..__________________________________________________________________ …………………………………………………………………………...................................................... LANDLINE NO.:……………………………..MOBILE NO.: …………………… E-MAIL: ……………………………………..
  2. 2. NATIONAL EDUCATION FOUNDATION NO OBJECTION CERTIFICATE FROM COLLEGE ANNEXURE IIThat I,______________________________________________________________________________asprincipal of ______________________________________________college have gone through the detailedinformation, rules and regulations of the K2S - The Monsoon Night Adventure Race organized by NEF, Puneand to be held in the hilly region from Katraj Tunnel to Sinhagad Fort that,1. Name: , age : , year / course2. Name: , age : , year / course3. Name : , age : , year / courseare the students of this College and so are known to me. I therefore have no objection in the above students, participating/representing this college in the saidrace and event as per the strict rules and procedures of the race.Place:______________Date:______________ College Stamp Principal’s Signature * Not applicable for category C - Collegian All Girls • D - Collegians Mix Open
  3. 3. NATIONAL EDUCATION FOUNDATIONPERSONAL INFORMATION FORM ANNEXURE – III (A)NAME: ………………………………………………………………………........................TEAM NAME: ………………………………………………………………………………..CATEGORY: ……………………………………………………………………………………………………ADDRESS: ………………………………………………………………………………….. Self Attested………………………………………………………………………………………………… PhotographPH.NOS: ……………………………………………………………………………………E-MAIL: ………………………………………………………………………………………___________________________________________________________________NAME: ………………………………………………………………………………………..ADDRESS: ………………………………………………………………………………….…………………………………………………………………………………………………LANDLINE: ……………………………….. MOBILE: ……………………………………_________________________________________________________________OCCUPATION: ……………………………………EDUCATION: ……………………….COLLEGE: …………………………………………………………………………………..YEAR/COURSE: ………………………………………………………………………….BIRTH DATE: …………………………..AGE:…………………..yrs.M/F: ……………….. HEIGHT: ………………………. WEIGHT: …………………..BLOOD GROUP: ……………. SIGNATURE & NAMEINSURANCE POLICY NO(compulsory) : ………………………………………………… ________________PREVIOUS EXPERIENCE IN SPORTS: ………………………………………………… ________________
  4. 4. NATIONAL EDUCATION FOUNDATION DECLARATION BY PARENT / GUARDIAN ANNEXURE – IV (A)I,………………………………………………………………………… age………………….. : years,Occupation : ……………………………………,residing at ………………………………………….........................………………………………………………………………………………………………………………………………The father/mother/guardian of Master/Miss ……………………………………………………………………………Age: ………………….Occupation: …………………. , residing at …………………………………………………...Declare that -1) My son/daughter/ward is participating in K2S-The Monsoon Night Adventure Race 2011 with my permissionand consent, after I have gone through all the Rules and Terms and Conditions formed by the NationalEducation Foundation (NEF).2) I declare that I shall not disclose any information relating to any of the terms and conditions, instances,incident and any other matter taking place during the race and any information obtained by NEF for the purposeof this Race without, the previous permission in writing from NEF officials, in any manner whatsoever to anyPerson / individual/ organization / body corporate / agency etc.3) I declare that all the decisions taken by the NEF or/and/by the Director or other members, or any otherperson authorized by NEF for the purpose of completion of the Race in proper manner or in the interest of myson/daughter/ward, in the circumstances then prevailing shall be binding on him/her.4) I declare that after having understood all the Rules and Regulations and Terms and Conditions formed by theNEF for K2S-The Monsoon Night Adventure Race and after being aware of this risks involved in the Race havedecided to permit my son/daughter/ward to participate in the Race on my own volition, responsibility and withoutany coercion or influence by anyone. I shall not hold the NEF or its Director or any other members, or any otherperson authorized by the NEF responsible on any count including any injury and/or damage to myson/daughter/ward or to his/her person or property.5) I declare that all the necessary information/documents furnished by me and my son/daughter/ward to theorganizers is true and correct to the best of my knowledge, belief and information.In verification whereof I have signed below this Declaration on this…………day of……….. 2011.Place:……………………. Mr/Mrs……………………………………………………………...Date :……………………... Father/Mother/Guardian of ……………………………………… Phone No.: ………………………………………………………. _________________________ Signature of Parent / Guardian
  5. 5. NATIONAL EDUCATION FOUNDATION DECLARATION BY PARTICIPANT ANNEXURE – V (A)I,………………………………………………………………………………………………………………………………………………………. Age ……….. Years, Occupation: …………………………………………………………………………………………………………………………………………………Residing at ………………..............………………………………………………………………………………………………….. declare that,1) I have gone through all the Rules and Regulations and the Terms And Conditions formed by the NationalEducation Foundation (NEF) for K2S-The Monsoon Night Adventure Race and have understood the same.I am also aware that all this Rules and Regulations and the Terms and Conditions are binding on me as aparticipant.2) I declare that,I shall not disclose any information relating to any of the terms and conditions ,instance,incident and any other matter taking palce during the Race and any information obtained by the NEF for thepurpose of this Race without the previous permission in writing from NEF Officials, in any manner whatsoeverto any person/organization/body agency etc.3) I declare that all the decisions taken by the NEF or /and by the Director or other members, or any otherperson authorized by the NEF for the purpose of completing the Race In proper manner or in the interest ofmyself, in the circumstances then prevailing shall be binding on me.4) I further declare that after having understood all the Rules and Regulations and the Terms and Conditionsformed by the NEF for the Race and after being aware of the risks involved ind the Race I have decided toparticipate in the Race on my own volition, responsibility and without any coercion or influence by anyoneincluding my parents/guardians.5) I shall not hold the NEF or its Director or other members or any other person autorised by the NEF responsible on any count including any injury and/or damage to me/my person or my property. I declare that all the necessary information/ documents furnished by me to the Organizers are true and correct to the best of my knowledge, belief and information. ’In verification whereof, I have signed below this declaration on this ……………………day of ………………….. 2011’. Place: Name:…………………………. Date: Signature:………………………… Phone No:………………………….Witness:Name : ………………………..Address:…………………………………………..
  6. 6. NATIONAL EDUCATION FOUNDATION CERTIFICATE OF PHYSICAL FITNESS ANNEXURE – VI (A)Name of the doctor: ………………………………………………………………………………………Qualification: ………………………………………………………………………………………………This is to certify that I have conducted clinical examination ofMr. / Mrs. / Miss …………………………………………………………………………………………Who is desirous of participating in NEF K2S-The Monsoon Night Adventure RaceHe has not given any personal history of any disease incapacitating him to undergo the physicallydemanding. NEF K2S-The Monsoon Night Adventure Race. Also on clinical examination it has been foundthat he is physically fit to undergo the above mentioned Race.Certified further that he has not shown any evidence of major defects of posture, locomotion, vision, hearing orany other systemic disorders.Even though the following deviations have been revealed.1._________________________________________________________________________2._________________________________________________________________________3._________________________________________________________________________I do not feel that this could hinder his participation in the above mentioned Race on any of the health ground/s. ……………….. ………….. …………………………… PARTICIPANT DOCTOR PARENT/GUARDIAN (STAMP)
  7. 7. NATIONAL EDUCATION FOUNDATIONPERSONAL INFORMATION FORM ANNEXURE –III (B)NAME: ……………………………………………………………………….....................TEAM NAME: ……………………………………………………………………………..CATEGORY:…………………………………………………………………………………………………ADDRESS :……………………………………………………………………………….. Self Attested……………………………………………………………………………………………… PhotographPH. NOS.:………………………………………………………………………………….E-MAIL:……………………………………………………………………………………._________________________________________________________________NAME: ………………………………………………………………………………………ADDRESS : ………………………………………………………………………………..LANDLINE: ……………………………….. MOBILE: ………………………………….__________________________________________________________________OCCUPATION: ……………………………………EDUCATION: ……………………..COLLEGE: …………………………………………………………………………………YEAR/COURSE: ………………………………………………………………………..BIRTH DATE: …………………………..AGE:…………………yrs.M/F: ……………….. HEIGHT: ………………………. WEIGHT: …………………..BLOOD GROUP: ……………. SIGNATURE & NAMEINSURANCE POLICY NO(compulsory): ……………………………............................ _______________PREVIOUS EXPERIENCE IN SPORTS: ……………………………………………… ________________
  8. 8. NATIONAL EDUCATION FOUNDATION DECLARATION BY PARENT / GUARDIAN ANNEXURE – IV (B)I,………………………………………………………………………… age………………….. : years,Occupation : ……………………………………,residing at………………………………………….........................……………………………………………………………………………………………………………………………..The father/mother/guardian of Master/Miss ………………………………………………………………………….age : ………………….Occupation,………………….. , residing at …………………………………………………declare that -1) My son/daughter/ward is participating in K2S-The Monsoon Night Adventure Race 2011 with my permissionand consent, after I have gone through all the Rules and Terms and Conditions formed by the NationalEducation Foundation (NEF).2) I declare that I shall not disclose any information relating to any of the terms and conditions, instances,incident and any other matter taking place during the race and any information obtained by NEF for thepurpose of this Race without, the previous permission in writing from NEF officials, in any manner whatsoeverto any Person / individual/ organization / body corporate / agency etc.3) I declare that all the decisions taken by the NEF or/and/by the Director or other members, or any otherperson authorized by NEF for the purpose of completion of the Race in proper manner or in the interest of myson/daughter/ward, in the circumstances then prevailing shall be binding on him/her.4) I declare that after having understood all the Rules and Regulations and Terms and Conditions formed bythe NEF for K2S-The Monsoon Night Adventure Race and after being aware of this risks involved in the Racehave decided to permit my son/daughter/ward to participate in the Race on my own volition, responsibility andwithout any coercion or influence by anyone. I shall not hold the NEF or its Director or any other members, orany other person authorized by the NEF responsible on any count including any injury and/or damage to myson/daughter/ward or to his/her person or property.5) I declare that all the necessary information/documents furnished by me and my son/daughter/ward to theorganizers is true and correct to the best of my knowledge, belief and information.In verification whereof I have signed below this Declaration on this ……………… day of …………. 2011.Place : ……………………. Mr/Mrs……………………………………………………………...Date : ……………………... Father/Mother/Guardian of ………………………………………Phone No.: ……………………… _________________________ Signature of Parent / Guardian
  9. 9. NATIONAL EDUCATION FOUNDATION DECLARATION BY PARTICIPANT ANNEXURE – V (B)I, ………………………………………………………………………………………………………………………………………………………. Age ……….. Years, Occupation: …………………………………………………………………………………………………………………………………………………Residing at ………………..............………………………………………………………………………………………………….. declare that,1) I have gone through all the Rules and Regulations and the Terms And Conditions formed by the NationalEducation Foundation (NEF) for K2S-The Monsoon Night Adventure Race and have understood the same. Iam also aware that all this Rules and Regulations and the Terms and Conditions are binding on me as aparticipant.2) I declare that,I shall not disclose any information relating to any of the terms and conditions ,instance,incident and any other matter taking palce during the Race and any information obtained by the NEF for thepurpose of this Race without the previous permission in writing from NEF Officials, in any manner whatsoever toany person/organization/body agency etc.3) I declare that all the decisions taken by the NEF or /and by the Director or other members, or any otherperson authorized by the NEF for the purpose of completing the Race In proper manner or in the interest ofmyself, in the circumstances then prevailing shall be binding on me.4) I further declare that after having understood all the Rules and Regulations and the Terms and Conditionsformed by the NEF for the Race and after being aware of the risks involved ind the Race I have decided toparticipate in the Race on my own volition, responsibility and without any coercion or influence by anyoneincluding my parents/guardians.6) I shall not hold the NEF or its Director or other members or any other person autorised by the NEF responsible on any count including any injury and/or damage to me/my person or my property. I declare that all the necessary information/ documents furnished by me to the Organizers are true and correct to the best of my knowledge, belief and information. ’In verification whereof, I have signed below this declaration on this ……………………day of ………………….. 2011’. Place: Name:…………………………. Date: Signature:………………………… Phone No:………………………….Witness:Name : ………………………..Address:…………………………………………..
  10. 10. NATIONAL EDUCATION FOUNDATION CERTIFICATE OF PHYSICAL FITNESS ANNEXURE – VI (B)Name of the doctor : ………………………………………………………………………………………Qualification : ………………………………………………………………………………………………This is to certify that I have conducted clinical examination ofMr. / Mrs. / Miss …………………………………………………………………………………………who is desirous of participating in NEF K2S-The Monsoon Night Adventure RaceHe has not given any personal history of any disease incapacitating him to undergo the physicallyDemanding. Also on clinical examination it has been found that he is physically fit to undergo the abovementioned Race.Certified further that he has not shown any evidence of major defects of posture, locomotion, vision herein or anyother systemic disorder.Even though the following deviations have been revealed.1._________________________________________________________________________2._________________________________________________________________________3._________________________________________________________________________I do not feel that this could hinder his participation in the above mentioned Race on any of the health ground/s. ……………….. ………….. …………………………… PARTICIPANT DOCTOR PARENT/GUARDIAN (STAMP)
  11. 11. NATIONAL EDUCATION FOUNDATIONPERSONAL INFORMATION FORM ANNEXURE –III (C)NAME: ……………………………………………………………………….....................TEAM NAME: ……………………………………………………………………………..CATEGORY:…………………………………………………………………………………………………ADDRESS :……………………………………………………………………………….. Self Attested……………………………………………………………………………………………… PhotographPH. NOS.:………………………………………………………………………………….E-MAIL:……………………………………………………………………………………..___________________________________________________________________NAME: ………………………………………………………………………………………ADDRESS : ………………………………………………………………………………..……………………………………………………………………………………………….LANDLINE: ……………………………….. MOBILE: ………………………………….__________________________________________________________________OCCUPATION: ……………………………………EDUCATION: ……………………..COLLEGE: …………………………………………………………………………………YEAR/COURSE: ………………………………………………………………………..BIRTH DATE: …………………………..AGE :…………………yrs.M/F: ……………….. HEIGHT: ………………………. WEIGHT: …………………..BLOOD GROUP: …………….INSURANCE POLICY NO(compulsory) : …………………………. SIGNATURE & NAMEPREVIOUS EXPERIENCE IN SPORTS: ……………………………………………… ________________ _________________
  12. 12. NATIONAL EDUCATION FOUNDATION DECLARATION BY PARENT / GUARDIAN ANNEXURE – IV (C)I,………………………………………………………………………… age………………….. : years,Occupation : ……………………………………,residing at ………………………………………….......................……………………………………………………………………………………………………………………………..The father/mother/guardian of Master/Miss ………………………………………………………………………….age : ………………….Occupation,………………….. , residing at …………………………………………………. declare that -1) My son/daughter/ward is participating in K2S-The Monsoon Night Adventure Race 2011 with my permissionand consent, after I have gone through all the Rules and Terms and Conditions formed by the NationalEducation Foundation (NEF).2) I declare that I shall not disclose any information relating to any of the terms and conditions, instances,incident and any other matter taking place during the race and any information obtained by NEF for the purposeof this Race without, the previous permission in writing from NEF officials, in any manner whatsoever to anyPerson / individual/ organization / body corporate / agency etc.3) I declare that all the decisions taken by the NEF or/and/by the Director or other members, or any otherperson authorized by NEF for the purpose of completion of the Race in proper manner or in the interest of myson/daughter/ward, in the circumstances then prevailing shall be binding on him/her.4) I declare that after having understood all the Rules and Regulations and Terms and Conditions formed by theNEF for K2S-The Monsoon Night Adventure Race and after being aware of this risks involved in the Race havedecided to permit my son/daughter/ward to participate in the Race on my own volition, responsibility and withoutany coercion or influence by anyone. I shall not hold the NEF or its Director or any other members, or any otherperson authorized by the NEF responsible on any count including any injury and/or damage to myson/daughter/ward or to his/her person or property.5) I declare that all the necessary information/documents furnished by me and my son/daughter/ward to theorganizers is true and correct to the best of my knowledge, belief and information.In verification whereof I have signed below this Declaration on this………………day of………….2011.Place :……………………. Mr/Mrs……………………………………………………………...Date :……………………... Father/Mother/Guardian of ………………………………………Phone No.: ……………………… _________________________ Signature of Parent / Guardian
  13. 13. NATIONAL EDUCATION FOUNDATION DECLARATION BY PARTICIPANT ANNEXURE – V (C)I,……………………………………………………………………………………………………………………………………………………. Age ……….. Years, Occupation: …………………………………………………………………………………………………………………………………………………Residing at ………………..............………………………………………………………………………………………………….. declare that,1) I have gone through all the Rules and Regulations and the Terms And Conditions formed by theNational Education Foundation (NEF) for K2S-The Monsoon Night Adventure Race and haveunderstood the same. I am also aware that all this Rules and Regulations and the Terms and Conditionsare binding on me as a participant.2) I declare that,I shall not disclose any information relating to any of the terms and conditions ,instance,incident and any other matter taking palce during the Race and any information obtained by the NEF forthe purpose of this Race without the previous permission in writing from NEF Officials, in any mannerwhatsoever to any person/organization/body agency etc.3) I declare that all the decisions taken by the NEF or /and by the Director or other members, or any otherperson authorized by the NEF for the purpose of completing the Race In proper manner or in the interest ofmyself, in the circumstances then prevailing shall be binding on me.4) I further declare that after having understood all the Rules and Regulations and the Terms andConditions formed by the NEF for the Race and after being aware of the risks involved ind the Race I havedecided to participate in the Race on my own volition, responsibility and without any coercion or influenceby anyone including my parents/guardians.7) I shall not hold the NEF or its Director or other members or any other person autorised by the NEF responsible on any count including any injury and/or damage to me/my person or my property. I declare that all the necessary information/ documents furnished by me to the Organizers are true and correct to the best of my knowledge, belief and information. ’In verification whereof, I have signed below this declaration on this ……………………day of ………………….. 2011’. Place: Name:…………………………. Date: Signature:………………………… Phone No:………………………….Witness:Name : ………………………..Address:…………………………………………..
  14. 14. NATIONAL EDUCATION FOUNDATION CERTIFICATE OF PHYSICAL FITNESS ANNEXURE - VI (C)Name of the doctor : ………………………………………………………………………………………Qualification : ………………………………………………………………………………………………This is to certify that I have conducted clinical examination ofMr. / Mrs. / Miss …………………………………………………………………………………………who is desirous of participating in NEF K2S-The Monsoon Night Adventure Race 2011He has not given any personal history of any disease incapacitating him to undergo the physicallydemanding. Also on clinical examination it has been found that he is physically fit to undergo the abovementioned Race.Certified further that he has not shown any evidence of major defects of posture, locomotion, vision hearingor any other systemic disorder.Even though following the deviations have been revealed.1._________________________________________________________________________2._________________________________________________________________________3._________________________________________________________________________I do not feel that this could hinder his participation in the above mentioned Race on any of the healthground/s. ……………….. ………….. …………………………… PARTICIPANT DOCTOR PARENT/GUARDIAN (STAMP)

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