INDEMNITY FORM
IMPORTANT:
Students are required to complete and return the form to the group instructor before leaving UPM campus.
INDEMNITY FORM FOR LAX ACTIVITIES (click here to download form)
IMPORTANT:
Students are required to complete
and return the form to the group instructor before
leaving UPM campus.
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LAX Name & Code
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Group No.
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List of Group Members Involved &
Matric No
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Name
Matric No
1.
2.
3.
4.
5.
6.
*Add the list if needed
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Destination
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Instructor
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I
am aware that if I decide to conduct my LAX activities outside of UPM campus, I
take full responsibility for any risks, dangers and hazards that may occur
including but not limited to physical injuries and damage or loss of personal
property while participating in the activities.
I have read and
understood this agreement.
(Group
Leader)
Signature: …………………………….. Date: ……………………………..
Name: …………………………………………………………….
Matric: …………………………… Contact No: ………………………………
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Approved/Received
by,
Signature: …………………………….. Date: ……………………………..
Instructor’s
Name / Official Stamp: …………………………………………………………….……