* Required

Name *

Your Email ID *

Contact Address *

Date of Birth (mm/dd/yyyy)*

Parents Name

Person / Parent / Guardian Email ID

Phone Number

Mobile Number *

Trek To ( Place as per the event sent ) *

Blood Group *

History of Previous Illness If Any ( In case of non use "N/A") *

Enter Above Character Here: *

Declaration : *
Yes,
- I am fully aware of the dangers and difficulties involved in the adventure activities and will not hold the club responsible for my own actions and involvement.
- I abide by the rules and regulations framed by the club and any subsequent amendments to it.
- I have or will clearly outline to the organiser any physical restrictions and disabilities or any predisposition to sickness or injury that I may have.
- I will take full responsibility for any injury, loss or damage to my person and / or property that may arise directly or indirectly from my participation.