Youth For Future

Ruko Venture A6-A7, Lippo Cikarang, Jakarta-Indonesia

www.youthff.com | admin@youthff.com | +62 856 9412 2100

INDEMNITY FORM

Please sign and scan this form, then send back to the committee.

I, The undersigned below, hereby declare that I am participating in the Future Leader Camp
Batik Festival 2018 Program in Kyoto, Japan , January 21st – 25th, 2018, with my own free
will and volition, having understood the risks involved in the above mentioned activity. I shall
not hold the organizers of the above mentioned activity, namely the Youth For Future and
Rumah Kepemimpinan responsible in any way for my death, injury or disability or any loss or
damage whatsoever arising from any cause in connection with the activity or my participation
there in.
02, December, 2017

( Sandi Irawan)

Parental consent for participant below 18 years old

I, hereby allow my child/ward* to participate in the above
activity, having understood the risks involved in the above mentioned activity. I understand
and agree that I will have no claim whatsoever and howsoever against the organizers, the
Youth For Future and Rumah Kepemimpinan any injury or loss of any kind including
loss of life that my *child/ward may sustain during the whole period of the above mentioned
activity.
, January , 2016

( )
Full name
Contact information in emergency case
Name : Gandi Irawan
Email : gandisubara1401@gmail.com
Mobile Number : 085210341344
Relation : young brother