K2 s form_final

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 – I TEAM CATEGORY: ………………………………………………………………………...

TEAM NAME: ……………………………………………………………………………….. (FOR OFFICE USE ONLY)

NAME OF COLLEGE: ………………………………………………………………………………………

ADDRESS OF COLLEGE………………………………………………….……………. A __________________________________________________________________

A Team Leader: …………………………………………………………………………

AGE: ……… M/F T-SHIRT SIZE: S / M / L / XL/ XXL BIRTH DATE: …………………………PHONE NO.: ……………………………… BLOOD GROUP: …….. EMAIL ID…………………………………………………. __________________________________________________________________

B

B NAME…………………………………………………………………………………

AGE: ……… M/F T-SHIRT SIZE: S / M / L / XL/ XXL BIRTH DATE: …………………………PHONE NO: ………………………. BLOOD GROUP: …….. EMAIL ID:…………………………………………………. __________________________________________________________________

C NAME…………………………………………………………………………………. C

AGE: ……… M/F T-SHIRT SIZE: S / M / L / XL/ XXL BIRTH DATE: ………………………… PHONE NO: ……………………………. BLOOD GROUP: ……… EMAIL ID……………………………………………….. __________________________________________________________________

………………………………………………………………………….. .................................................... LANDLINE NO.:…………………………….. MOBILE NO.: …………………… E-MAIL: ……………………………………..

Self Attested

Photograph

Self Attested

Photograph

Self Attested

Photograph

NATIONAL EDUCATION FOUNDATION NO OBJECTION CERTIFICATE FROM COLLEGE ANNEXURE II

That I,______________________________________________________________________________as

principal of ______________________________________________college have gone through the detailed

information, rules and regulations of the K2S - The Monsoon Night Adventure Race organized by NEF, Pune

and to be held in the hilly region from Katraj Tunnel to Sinhagad Fort that,

1. Name: , age : , year / course

2. Name: , age : , year / course

3. Name : , age : , year / course are 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 said race 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

NATIONAL EDUCATION FOUNDATION

PERSONAL INFORMATION FORM ANNEXURE – III (A)

NAME: ………………………………………………………………………........................

TEAM NAME: ……………………………………………………………………………….. CATEGORY: ……………………………………………………………………………………………………

ADDRESS: ………………………………………………………………………………….. ………………………………………………………………………………………………… PH.NOS: …………………………………………………………………………………… E-MAIL: ……………………………………………………………………………………… ___________________________________________________________________

NAME: ……………………………………………………………………………………….. ADDRESS: …………………………………………………………………………………. ………………………………………………………………………………………………… LANDLINE: ……………………………….. MOBILE: …………………………………… _________________________________________________________________

OCCUPATION: ……………………………………EDUCATION: ………………………. COLLEGE: ………………………………………………………………………………….. YEAR/COURSE: …………………………………………………………………………. BIRTH DATE: …………………………..AGE:…………………..yrs.

M/F: ……………….. HEIGHT: ………………………. WEIGHT: ………………….. BLOOD GROUP: ……………. SIGNATURE & NAME INSURANCE POLICY NO(compulsory) : ………………………………………………… ________________ PREVIOUS EXPERIENCE IN SPORTS: ………………………………………………… ________________

Self

Attested

Photograph

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 permission and consent, after I have gone through all the Rules and Terms and Conditions formed by the National Education 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 purpose of this Race without, the previous permission in writing from NEF officials, in any manner whatsoever to 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 other person authorized by NEF for the purpose of completion of the Race in proper manner or in the interest of my son/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 the NEF for K2S-The Monsoon Night Adventure Race and after being aware of this risks involved in the Race have decided to permit my son/daughter/ward to participate in the Race on my own volition, responsibility and without any coercion or influence by anyone. I shall not hold the NEF or its Director or any other members, or any other person authorized by the NEF responsible on any count including any injury and/or damage to my son/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 the organizers 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

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 National Education 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 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 for the purpose of this Race without the previous permission in writing from NEF Officials, in any manner whatsoever 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 other person authorized by the NEF for the purpose of completing the Race In proper manner or in the interest of myself, 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 Conditions formed by the NEF for the Race and after being aware of the risks involved ind the Race I have decided to participate in the Race on my own volition, responsibility and without any coercion or influence by anyone including 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:…………………………………………..

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 of Mr. / Mrs. / Miss ………………………………………………………………………………………… Who is desirous of participating in NEF K2S-The Monsoon Night Adventure Race He has not given any personal history of any disease incapacitating him to undergo the physically demanding. NEF K2S-The Monsoon Night Adventure Race. Also on clinical examination it has been found that 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 or any 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)

NATIONAL EDUCATION FOUNDATION

PERSONAL INFORMATION FORM ANNEXURE –III (B)

NAME: ……………………………………………………………………….....................

TEAM NAME: ……………………………………………………………………………..

CATEGORY:…………………………………………………………………………………………………

ADDRESS :……………………………………………………………………………….. ……………………………………………………………………………………………… PH. NOS.:…………………………………………………………………………………. E-MAIL:……………………………………………………………………………………. _________________________________________________________________

NAME: ……………………………………………………………………………………… ADDRESS : ……………………………………………………………………………….. LANDLINE: ……………………………….. MOBILE: …………………………………. __________________________________________________________________

OCCUPATION: ……………………………………EDUCATION: …………………….. COLLEGE: ………………………………………………………………………………… YEAR/COURSE: ……………………………………………………………………….. BIRTH DATE: …………………………..AGE:…………………yrs.

M/F: ……………….. HEIGHT: ………………………. WEIGHT: ………………….. BLOOD GROUP: ……………. SIGNATURE & NAME INSURANCE POLICY NO(compulsory): ……………………………............................ _______________ PREVIOUS EXPERIENCE IN SPORTS: ……………………………………………… ________________

Self

Attested

Photograph

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 permission and consent, after I have gone through all the Rules and Terms and Conditions formed by the National Education 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 purpose of this Race without, the previous permission in writing from NEF officials, in any manner whatsoever to 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 other person authorized by NEF for the purpose of completion of the Race in proper manner or in the interest of my son/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 the NEF for K2S-The Monsoon Night Adventure Raceand after being aware of this risks involved in the Race have decided to permit my son/daughter/ward to participate in the Race on my own volition, responsibility and without any coercion or influence by anyone. I shall not hold the NEF or its Director or any other members, or any other person authorized by the NEF responsible on any count including any injury and/or damage to my son/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 the organizers 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

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 National Education 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 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 for the purpose of this Race without the previous permission in writing from NEF Officials, in any manner whatsoever 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 other person authorized by the NEF for the purpose of completing the Race In proper manner or in the interest of myself, 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 Conditions formed by the NEF for the Race and after being aware of the risks involved ind the Race I have decided to participate in the Race on my own volition, responsibility and without any coercion or influence by anyone including 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:…………………………………………..

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 of Mr. / Mrs. / Miss ………………………………………………………………………………………… who is desirous of participating in NEF K2S-The Monsoon Night Adventure Race

He has not given any personal history of any disease incapacitating him to undergo the physically Demanding. Also on clinical examination it has been found that 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 herein or any other 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)

NATIONAL EDUCATION FOUNDATION

PERSONAL INFORMATION FORM ANNEXURE –III (C)

NAME: ……………………………………………………………………….....................

TEAM NAME: …………………………………………………………………………….. CATEGORY:…………………………………………………………………………………………………

ADDRESS :……………………………………………………………………………….. ……………………………………………………………………………………………… PH. 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 & NAME PREVIOUS EXPERIENCE IN SPORTS: ……………………………………………… ________________ _________________

Self

Attested

Photograph

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 Race2011 with my permission and consent, after I have gone through all the Rules and Terms and Conditions formed by the National Education 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 purpose of this Race without, the previous permission in writing from NEF officials, in any manner whatsoever to 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 other person authorized by NEF for the purpose of completion of the Race in proper manner or in the interest of my son/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 the NEF for K2S-The Monsoon Night Adventure Raceand after being aware of this risks involved in the Race have decided to permit my son/daughter/ward to participate in the Race on my own volition, responsibility and without any coercion or influence by anyone. I shall not hold the NEF or its Director or any other members, or any other person authorized by the NEF responsible on any count including any injury and/or damage to my son/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 the organizers 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

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 the National Education 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 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 for the purpose of this Race without the previous permission in writing from NEF Officials, in any manner whatsoever 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 other person authorized by the NEF for the purpose of completing the Race In proper manner or in the interest of myself, 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 Conditions formed by the NEF for the Race and after being aware of the risks involved ind the Race I have decided to participate in the Race on my own volition, responsibility and without any coercion or influence by 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:…………………………………………..

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 of Mr. / Mrs. / Miss ………………………………………………………………………………………… who is desirous of participating in NEF K2S-The Monsoon Night Adventure Race2011 He has not given any personal history of any disease incapacitating him to undergo the physically demanding. Also on clinical examination it has been found that 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 or 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 health ground/s.

……………….. ………….. …………………………… PARTICIPANT DOCTOR PARENT/GUARDIAN

(STAMP)