PLEASE FILL IN AND SUBMIT THIS FORM TO YOUR GROUP LEADER

ON THURSDAY 29th JANUARY

ENBE/FNBE JAN 2015/DMZ

INDEMNITY FORM

This is to confirm that my son/daughter __________________________________________

will be participating in the following activity at the time and place specified below:

Activity : FNBE - ENBE PROJECT ONE – Site Visit

Purpose : As part of the ENBE Project One Project, in which students

have to conduct observation exercise and to experience and

appreciate nature at the sites allocated by the university

Place : DePalma Hotel KUALA SELANGOR

Jalan Tanjung Keramat

45000 Kuala Selangor

Selangor Darul Ehsan

Tel: 03-3289 7070 Fax: 03-3289 7080

Malaysian Nature Society,

Kuala Selangor Nature Park,

Jalan Klinik,

45000 Kuala Selangor,

Selangor

Date : 8th-10th February 2014

I understand that Taylor’s University will take all reasonable precautions to ensure the

safety of my son/daughter/ward and his/her property. I will not hold Taylor’s University

and/or the Management and/or the staff responsible for any loss, damage or injury

suffered directly or indirectly by my son/ daughter/ward in the course or as a result of

his/her participation.

Name of Parent/Guardian : __________________________________

Signature : __________________________________

Date : __________________________________

Contact No : __________________________________