BIODATA

Event: The Stars BRATs Young Journalist Camp 2017 Preferred camp: March June August (Circle one)

T-shirt size: S M L XL (Circle one only)

Name (as in NRIC): NRIC:

Date of Birth: Age: Gender: _ Form:

Tel No.: Hand phone: E-mail:

Address:

School: _

Extra-curricular activities, interests, and achievements (attach additional page if needed)

MEDICAL CONDITION

Please state present condition of health and give details of any illness or disability that requires attention, including
allergies and medication. (MANDATORY) Blood type : ___________________________________

Food Allergies (if yes, pls state) : _________________________________________________________

Family Doctor's Details (if any)

Doctor's Name : Tel No :

Address :

Parents' / Guardians' Details

Name : Occupation :

Tel No (Off) : Hand phone No. :

Name : Occupation :
Tel No (Off) : Hand phone No. :

Incomplete forms will not be accepted

To : The Star BRATs
Young Journalist Workshop 2016
C/o Marketing and Corporate Communications
Menara Star, 15 Jalan 16/11 Tel : 03-7967 1388
46350 Petaling Jaya Fax : 03-7957 7641
Selangor Darul Ehsan

LIABILITY DISCLAIMER FORM

I ______________________________ *(Parent / Guardian) of __________________________________

agree to my *son / daughter participating in The Star BRATs Young Journalist Camp 2017, venue to be
confirmed.

I hereby agree to indemnify and keep indemnifying Star Publications (M) Berhad and its staff against any
claim, demand or otherwise which may arise as a result of my child/ward being injured or suffering any loss
in the course of participating in The Star BRATs event.

For security and safety reasons, all participants are required to abide by the house rules and regulations
enforced by Star Publications (M) Berhad staff during this event. Star Publications (M) Berhad will not be
held responsible for any injury, accident or death caused before, during and after the event.

In case of accident or injury, I authorise the staff of Star Publications (M) Berhad to take my child to any
medical facility as is necessary in the event that I cannot be contacted. If medical treatment is required, I
authorise the staff of Star Publications (M) Berhad to consent on my behalf for the treatment.

If there is a conflict between participating in this Star BRATs event and school activities, my *son / daughter
will give priority to the school activities.

I also agree that in the event that my child/ward needs to leave The Star BRATs Young Journalist Camp, in
the midst of the programme, I will provide a written request at least two (2) days before the trip commences.
My child/ward will leave and return to the programme accompanied by either my spouse or me.

Signature of Parent / Guardian Signature of Participant

Name : Name :
NRIC : NRIC :
Date : Date :

Home address: