Office of Student Affairs
Sports & Recreation Centre
Health Declaration & Indemnity for Varsity Athletes (Annex A)
Please provide the requested information by completing the form below if you wish to be part of the varsity
team (s) that you are interested in. Your contact information will be passed to the respective Sports Manager
(staff) for information dissemination purposes.
By indicating your consent to provide your personal data in this form, you agree to receive publicity material,
updates and important announcements via email only.
All personal information will be kept confidential and only used for the purpose (s) stated.
To help you make an informed decision, withdrawing consent will result in failure to receive any updates on the
varsity team (s).
Should you wish to withdraw your consent for the varsity team to contact you for the purposes stated above,
please notify us in writing to sports@nus.edu.sg. We will then remove your email address information from our
database. Please allow for 5 business days for your withdrawal of consent to take effect.
personal data and pass the information only to Sports
Manager (staff) of the varsity team (s) that I am interested in for the purposes above.
Sports Manager (staff) of the varsity team (s) that I am interested in for the purposes above.
Information About Yourself
a. Name (as it appears in your NRIC/Passport):
b. Email:
c. Gender: Male / Female
d. Sport 1:
Sport 2:
Sport 3:
Declaration and Indemnity
a. I will ensure that at any time, I’m medically well and physically fit to undertake the rigors as required by the
sport.
b. I shall dutifully report to the team captain/manager and coach of any physical discomfort that may arise out
of my involvement in the sport.
c. I hereby declare that I am participating in the teamNUS Varsity Sports Programme which includes trainings
and competitions (the “Event”) of my own free will and volition, *am/is aware of the risks involved and in
consideration of being permitted by Sports & Recreation Centre, National University of Singapore (“NUS”) to
participate in the Event, I, for myself, my successors, personal representatives and assigns:
i. do hereby absolve, acquit and discharge NUS and its officers, servants, employees, agents or volunteers
from all or any responsibility, actions, causes of action, claims, demands and obligations whatsoever arising
from any loss or damage (including, without limitation and to the extent permissible by law, physical injury,
loss of life or property damage) caused by or sustained as a result of my participation in the Event; and
ii. will indemnify and keep indemnified, save and hold harmless NUS and its officers, servants, employees,
agents or volunteers against all losses, claims, demands, actions, proceedings, damages, costs or expenses,
including legal fees, and any other liability arising in any way from my participation in the Event.
 I have read and understood the Declaration set out above.
 I affirm the said declaration and agree to abide and be bound by the matters stated therein.
Name:
Signature:
Date:
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