YOUNG BATU

INTER-BRANCH FUTSAL CHALLENGE 2018

EVENT DETAILS

Date: 11th November 2018, Sunday

Time: 2 pm – 6 pm
Venue: Futsal Arena Singapore (32 Yishun Central 1 S768809)
Fee: $80.00/team (Min of 4 BATU Union Members per team)

TEAM DETAILS
Team Name: Branch/Company:

Team Manager: Contact No. (HP):

Email:

PLAYERS PARTICULARS

NAME (as in NRIC) NRIC/ FIN Number AGE Contact No. (HP)

(CAPTAIN)
1.
2.

3.

4.

5.

6.

7.

8.

1
 1. Player Name: ___________________________________

MEDICAL HISTORY
Have you ever had: Y N If yes, please specify:
Chest pain, high blood pressure, heart problems such as
heart murmurs, extra heart beat or other heart
abnormality?
Asthma, bronchitis, tuberculosis, sinusitis or other lung
problem?
Fits, epilepsy fainting attacks, migraine or severe head
injuries?
Eye problems/ poor vision?
Ear problems/ deafness?
Nervous illness?
Diabetes?
Bone or joint injury?
A carrier status for any infectious disease?
Medical treatment within last 2 years?

Do you require:
Routine medication? Y N If yes, please specify:

Do you have:
Any disabilities? Y N If yes, please specify:

Any other medical information to note?

E.g. Allergies
Any dietary preference? Y N If yes, please specify:

2
 Please read the following advisory:

1. It is deemed that all registered participants have consented to the collection, use and/or
disclosure of your personal particulars by BATU for the purposes of organising this event, and/or
used by Young BATU for analysis and research purposes pertaining only to matters in relation to
such events/programmes.

2. All registered participants will be included into the contact list of Young BATU, to receive regular
updates on future engagement events and programmes organised by Young BATU, as well as
opportunities to contribute, share opinions and/or feedback through any of the contacts
provided through any means.

3. Please update Young BATU of any changes in address or contact details so as to facilitate
communication.

4. Any photographs, motion pictures, recordings, or any other media records of this event may be
used by Young BATU for any legitimate purpose, including any commercial and marketing uses,
and/or to be uploaded onto Young BATU’s public sites and channels.

5. In the event that registered participants do not wish for his/her photographs and/or any other
media records of him/her at this event to be used by BATU, please inform and provide clear
instructions to Young BATU in writing at genevieve_wong@ntuc.org.sg

6. In the event that registered participants do not wish to receive regular updates on future
engagement events and programmes organised by Young BATU, as well as opportunities to
contribute, share opinions and/or feedback, please inform and provide clear instructions to
Young BATU in writing at genevieve_wong@ntuc.org.sg

7. No refund will be payable for non-attendance

DECLARATION

I hereby certify that the information given is to the best of my knowledge and I understand that elements
in the program may be physically and emotionally demanding.

I hereby declare that I shall hold blameless and indemnify The Building Construction And Timber Industries
Employees' Union, their employees, the Tournament Committee and appointed officials from any loss, cost,
damage and/or expense of any nature, including all attorneys’ fees and costs which I may have incurred
resulting, either directly or indirectly in my participation in the Young BATU Futsal Tournament.

_________________________________________
Signature of Participant & Date

3
 2. Player Name: ___________________________________

MEDICAL HISTORY
Have you ever had: Y N If yes, please specify:
Chest pain, high blood pressure, heart problems such as
heart murmurs, extra heart beat or other heart
abnormality?
Asthma, bronchitis, tuberculosis, sinusitis or other lung
problem?
Fits, epilepsy fainting attacks, migraine or severe head
injuries?
Eye problems/ poor vision?
Ear problems/ deafness?
Nervous illness?
Diabetes?
Bone or joint injury?
A carrier status for any infectious disease?
Medical treatment within last 2 years?

Do you require:
Routine medication? Y N If yes, please specify:

Do you have:
Any disabilities? Y N If yes, please specify:

Any other medical information to note?

E.g. Allergies
Any dietary preference? Y N If yes, please specify:

4
 Please read the following advisory:

1. It is deemed that all registered participants have consented to the collection, use and/or
disclosure of your personal particulars by BATU for the purposes of organising this event, and/or
used by Young BATU for analysis and research purposes pertaining only to matters in relation to
such events/programmes.

2. All registered participants will be included into the contact list of Young BATU, to receive regular
updates on future engagement events and programmes organised by Young BATU, as well as
opportunities to contribute, share opinions and/or feedback through any of the contacts
provided through any means.

3. Please update Young BATU of any changes in address or contact details so as to facilitate
communication.

4. Any photographs, motion pictures, recordings, or any other media records of this event may be
used by Young BATU for any legitimate purpose, including any commercial and marketing uses,
and/or to be uploaded onto Young BATU’s public sites and channels.

5. In the event that registered participants do not wish for his/her photographs and/or any other
media records of him/her at this event to be used by BATU, please inform and provide clear
instructions to Young BATU in writing at genevieve_wong@ntuc.org.sg

6. In the event that registered participants do not wish to receive regular updates on future
engagement events and programmes organised by Young BATU, as well as opportunities to
contribute, share opinions and/or feedback, please inform and provide clear instructions to
Young BATU in writing at genevieve_wong@ntuc.org.sg

7. No refund will be payable for non-attendance

DECLARATION
I hereby certify that the information given is to the best of my knowledge and I understand that elements
in the program may be physically and emotionally demanding.

I hereby declare that I shall hold blameless and indemnify The Building Construction And Timber Industries
Employees' Union, their employees, the Tournament Committee and appointed officials from any loss, cost,
damage and/or expense of any nature, including all attorneys’ fees and costs which I may have incurred
resulting, either directly or indirectly in my participation in the Young BATU Futsal Tournament.

_________________________________________
Signature of Participant & Date

5
 3. Player Name: ___________________________________

MEDICAL HISTORY
Have you ever had: Y N If yes, please specify:
Chest pain, high blood pressure, heart problems such as
heart murmurs, extra heart beat or other heart
abnormality?
Asthma, bronchitis, tuberculosis, sinusitis or other lung
problem?
Fits, epilepsy fainting attacks, migraine or severe head
injuries?
Eye problems/ poor vision?
Ear problems/ deafness?
Nervous illness?
Diabetes?
Bone or joint injury?
A carrier status for any infectious disease?
Medical treatment within last 2 years?

Do you require:
Routine medication? Y N If yes, please specify:

Do you have:
Any disabilities? Y N If yes, please specify:

Any other medical information to note?

E.g. Allergies
Any dietary preference? Y N If yes, please specify:

6
 Please read the following advisory:

1. It is deemed that all registered participants have consented to the collection, use and/or
disclosure of your personal particulars by BATU for the purposes of organising this event, and/or
used by Young BATU for analysis and research purposes pertaining only to matters in relation to
such events/programmes.

2. All registered participants will be included into the contact list of Young BATU, to receive regular
updates on future engagement events and programmes organised by Young BATU, as well as
opportunities to contribute, share opinions and/or feedback through any of the contacts
provided through any means.

3. Please update Young BATU of any changes in address or contact details so as to facilitate
communication.

4. Any photographs, motion pictures, recordings, or any other media records of this event may be
used by Young BATU for any legitimate purpose, including any commercial and marketing uses,
and/or to be uploaded onto Young BATU’s public sites and channels.

5. In the event that registered participants do not wish for his/her photographs and/or any other
media records of him/her at this event to be used by BATU, please inform and provide clear
instructions to Young BATU in writing at genevieve_wong@ntuc.org.sg

6. In the event that registered participants do not wish to receive regular updates on future
engagement events and programmes organised by Young BATU, as well as opportunities to
contribute, share opinions and/or feedback, please inform and provide clear instructions to
Young BATU in writing at genevieve_wong@ntuc.org.sg

7. No refund will be payable for non-attendance

DECLARATION

I hereby certify that the information given is to the best of my knowledge and I understand that elements
in the program may be physically and emotionally demanding.

I hereby declare that I shall hold blameless and indemnify The Building Construction And Timber Industries
Employees' Union, their employees, the Tournament Committee and appointed officials from any loss, cost,
damage and/or expense of any nature, including all attorneys’ fees and costs which I may have incurred
resulting, either directly or indirectly in my participation in the Young BATU Futsal Tournament.

_________________________________________
Signature of Participant & Date

7
 4. Player Name: ___________________________________

MEDICAL HISTORY
Have you ever had: Y N If yes, please specify:
Chest pain, high blood pressure, heart problems such as
heart murmurs, extra heart beat or other heart
abnormality?
Asthma, bronchitis, tuberculosis, sinusitis or other lung
problem?
Fits, epilepsy fainting attacks, migraine or severe head
injuries?
Eye problems/ poor vision?
Ear problems/ deafness?
Nervous illness?
Diabetes?
Bone or joint injury?
A carrier status for any infectious disease?
Medical treatment within last 2 years?

Do you require:
Routine medication? Y N If yes, please specify:

Do you have:
Any disabilities? Y N If yes, please specify:

Any other medical information to note?

E.g. Allergies
Any dietary preference? Y N If yes, please specify:

8
 Please read the following advisory:

1. It is deemed that all registered participants have consented to the collection, use and/or
disclosure of your personal particulars by BATU for the purposes of organising this event, and/or
used by Young BATU for analysis and research purposes pertaining only to matters in relation to
such events/programmes.

2. All registered participants will be included into the contact list of Young BATU, to receive regular
updates on future engagement events and programmes organised by Young BATU, as well as
opportunities to contribute, share opinions and/or feedback through any of the contacts
provided through any means.

3. Please update Young BATU of any changes in address or contact details so as to facilitate
communication.

4. Any photographs, motion pictures, recordings, or any other media records of this event may be
used by Young BATU for any legitimate purpose, including any commercial and marketing uses,
and/or to be uploaded onto Young BATU’s public sites and channels.

5. In the event that registered participants do not wish for his/her photographs and/or any other
media records of him/her at this event to be used by BATU, please inform and provide clear
instructions to Young BATU in writing at genevieve_wong@ntuc.org.sg

6. In the event that registered participants do not wish to receive regular updates on future
engagement events and programmes organised by Young BATU, as well as opportunities to
contribute, share opinions and/or feedback, please inform and provide clear instructions to
Young BATU in writing at genevieve_wong@ntuc.org.sg

7. No refund will be payable for non-attendance

DECLARATION

I hereby certify that the information given is to the best of my knowledge and I understand that elements
in the program may be physically and emotionally demanding.

I hereby declare that I shall hold blameless and indemnify The Building Construction And Timber Industries
Employees' Union, their employees, the Tournament Committee and appointed officials from any loss, cost,
damage and/or expense of any nature, including all attorneys’ fees and costs which I may have incurred
resulting, either directly or indirectly in my participation in the Young BATU Futsal Tournament.

_________________________________________
Signature of Participant & Date

9
 5. Player Name: ___________________________________

MEDICAL HISTORY
Have you ever had: Y N If yes, please specify:
Chest pain, high blood pressure, heart problems such as
heart murmurs, extra heart beat or other heart
abnormality?
Asthma, bronchitis, tuberculosis, sinusitis or other lung
problem?
Fits, epilepsy fainting attacks, migraine or severe head
injuries?
Eye problems/ poor vision?
Ear problems/ deafness?
Nervous illness?
Diabetes?
Bone or joint injury?
A carrier status for any infectious disease?
Medical treatment within last 2 years?

Do you require:
Routine medication? Y N If yes, please specify:

Do you have:
Any disabilities? Y N If yes, please specify:

Any other medical information to note?

E.g. Allergies
Any dietary preference? Y N If yes, please specify:

10
 Please read the following advisory:

1. It is deemed that all registered participants have consented to the collection, use and/or
disclosure of your personal particulars by BATU for the purposes of organising this event, and/or
used by Young BATU for analysis and research purposes pertaining only to matters in relation to
such events/programmes.

2. All registered participants will be included into the contact list of Young BATU, to receive regular
updates on future engagement events and programmes organised by Young BATU, as well as
opportunities to contribute, share opinions and/or feedback through any of the contacts
provided through any means.

3. Please update Young BATU of any changes in address or contact details so as to facilitate
communication.

4. Any photographs, motion pictures, recordings, or any other media records of this event may be
used by Young BATU for any legitimate purpose, including any commercial and marketing uses,
and/or to be uploaded onto Young BATU’s public sites and channels.

5. In the event that registered participants do not wish for his/her photographs and/or any other
media records of him/her at this event to be used by BATU, please inform and provide clear
instructions to Young BATU in writing at genevieve_wong@ntuc.org.sg

6. In the event that registered participants do not wish to receive regular updates on future
engagement events and programmes organised by Young BATU, as well as opportunities to
contribute, share opinions and/or feedback, please inform and provide clear instructions to
Young BATU in writing at genevieve_wong@ntuc.org.sg

7. No refund will be payable for non-attendance

DECLARATION

I hereby certify that the information given is to the best of my knowledge and I understand that elements
in the program may be physically and emotionally demanding.

I hereby declare that I shall hold blameless and indemnify The Building Construction And Timber Industries
Employees' Union, their employees, the Tournament Committee and appointed officials from any loss, cost,
damage and/or expense of any nature, including all attorneys’ fees and costs which I may have incurred
resulting, either directly or indirectly in my participation in the Young BATU Futsal Tournament.

_________________________________________
Signature of Participant & Date

11
 6. Player Name: ___________________________________

MEDICAL HISTORY
Have you ever had: Y N If yes, please specify:
Chest pain, high blood pressure, heart problems such as
heart murmurs, extra heart beat or other heart
abnormality?
Asthma, bronchitis, tuberculosis, sinusitis or other lung
problem?
Fits, epilepsy fainting attacks, migraine or severe head
injuries?
Eye problems/ poor vision?
Ear problems/ deafness?
Nervous illness?
Diabetes?
Bone or joint injury?
A carrier status for any infectious disease?
Medical treatment within last 2 years?

Do you require:
Routine medication? Y N If yes, please specify:

Do you have:
Any disabilities? Y N If yes, please specify:

Any other medical information to note?

E.g. Allergies
Any dietary preference? Y N If yes, please specify:

12
 Please read the following advisory:

1. It is deemed that all registered participants have consented to the collection, use and/or
disclosure of your personal particulars by BATU for the purposes of organising this event, and/or
used by Young BATU for analysis and research purposes pertaining only to matters in relation to
such events/programmes.

2. All registered participants will be included into the contact list of Young BATU, to receive regular
updates on future engagement events and programmes organised by Young BATU, as well as
opportunities to contribute, share opinions and/or feedback through any of the contacts
provided through any means.

3. Please update Young BATU of any changes in address or contact details so as to facilitate
communication.

4. Any photographs, motion pictures, recordings, or any other media records of this event may be
used by Young BATU for any legitimate purpose, including any commercial and marketing uses,
and/or to be uploaded onto Young BATU’s public sites and channels.

5. In the event that registered participants do not wish for his/her photographs and/or any other
media records of him/her at this event to be used by BATU, please inform and provide clear
instructions to Young BATU in writing at genevieve_wong@ntuc.org.sg

6. In the event that registered participants do not wish to receive regular updates on future
engagement events and programmes organised by Young BATU, as well as opportunities to
contribute, share opinions and/or feedback, please inform and provide clear instructions to
Young BATU in writing at genevieve_wong@ntuc.org.sg

7. No refund will be payable for non-attendance

DECLARATION

I hereby certify that the information given is to the best of my knowledge and I understand that elements
in the program may be physically and emotionally demanding.

I hereby declare that I shall hold blameless and indemnify The Building Construction And Timber Industries
Employees' Union, their employees, the Tournament Committee and appointed officials from any loss, cost,
damage and/or expense of any nature, including all attorneys’ fees and costs which I may have incurred
resulting, either directly or indirectly in my participation in the Young BATU Futsal Tournament.

_________________________________________
Signature of Participant & Date

13
 7. Player Name: ___________________________________

MEDICAL HISTORY
Have you ever had: Y N If yes, please specify:
Chest pain, high blood pressure, heart problems such as
heart murmurs, extra heart beat or other heart
abnormality?
Asthma, bronchitis, tuberculosis, sinusitis or other lung
problem?
Fits, epilepsy fainting attacks, migraine or severe head
injuries?
Eye problems/ poor vision?
Ear problems/ deafness?
Nervous illness?
Diabetes?
Bone or joint injury?
A carrier status for any infectious disease?
Medical treatment within last 2 years?

Do you require:
Routine medication? Y N If yes, please specify:

Do you have:
Any disabilities? Y N If yes, please specify:

Any other medical information to note?

E.g. Allergies
Any dietary preference? Y N If yes, please specify:

14
 Please read the following advisory:

1. It is deemed that all registered participants have consented to the collection, use and/or
disclosure of your personal particulars by BATU for the purposes of organising this event, and/or
used by Young BATU for analysis and research purposes pertaining only to matters in relation to
such events/programmes.

2. All registered participants will be included into the contact list of Young BATU, to receive regular
updates on future engagement events and programmes organised by Young BATU, as well as
opportunities to contribute, share opinions and/or feedback through any of the contacts
provided through any means.

3. Please update Young BATU of any changes in address or contact details so as to facilitate
communication.

4. Any photographs, motion pictures, recordings, or any other media records of this event may be
used by Young BATU for any legitimate purpose, including any commercial and marketing uses,
and/or to be uploaded onto Young BATU’s public sites and channels.

5. In the event that registered participants do not wish for his/her photographs and/or any other
media records of him/her at this event to be used by BATU, please inform and provide clear
instructions to Young BATU in writing at genevieve_wong@ntuc.org.sg

6. In the event that registered participants do not wish to receive regular updates on future
engagement events and programmes organised by Young BATU, as well as opportunities to
contribute, share opinions and/or feedback, please inform and provide clear instructions to
Young BATU in writing at genevieve_wong@ntuc.org.sg

DECLARATION

I hereby certify that the information given is to the best of my knowledge and I understand that elements
in the program may be physically and emotionally demanding.

I hereby declare that I shall hold blameless and indemnify The Building Construction And Timber Industries
Employees' Union, their employees, the Tournament Committee and appointed officials from any loss, cost,
damage and/or expense of any nature, including all attorneys’ fees and costs which I may have incurred
resulting, either directly or indirectly in my participation in the Young BATU Futsal Tournament.

_________________________________________
Signature of Participant & Date

15
 8. Player Name: ___________________________________

MEDICAL HISTORY
Have you ever had: Y N If yes, please specify:
Chest pain, high blood pressure, heart problems such as
heart murmurs, extra heart beat or other heart
abnormality?
Asthma, bronchitis, tuberculosis, sinusitis or other lung
problem?
Fits, epilepsy fainting attacks, migraine or severe head
injuries?
Eye problems/ poor vision?
Ear problems/ deafness?
Nervous illness?
Diabetes?
Bone or joint injury?
A carrier status for any infectious disease?
Medical treatment within last 2 years?

Do you require:
Routine medication? Y N If yes, please specify:

Do you have:
Any disabilities? Y N If yes, please specify:

Any other medical information to note?

E.g. Allergies
Any dietary preference? Y N If yes, please specify:

16
 Please read the following advisory:

1. It is deemed that all registered participants have consented to the collection, use and/or
disclosure of your personal particulars by BATU for the purposes of organising this event, and/or
used by Young BATU for analysis and research purposes pertaining only to matters in relation to
such events/programmes.

2. All registered participants will be included into the contact list of Young BATU, to receive regular
updates on future engagement events and programmes organised by Young BATU, as well as
opportunities to contribute, share opinions and/or feedback through any of the contacts
provided through any means.

3. Please update Young BATU of any changes in address or contact details so as to facilitate
communication.

4. Any photographs, motion pictures, recordings, or any other media records of this event may be
used by Young BATU for any legitimate purpose, including any commercial and marketing uses,
and/or to be uploaded onto Young BATU’s public sites and channels.

5. In the event that registered participants do not wish for his/her photographs and/or any other
media records of him/her at this event to be used by BATU, please inform and provide clear
instructions to Young BATU in writing at genevieve_wong@ntuc.org.sg

6. In the event that registered participants do not wish to receive regular updates on future
engagement events and programmes organised by Young BATU, as well as opportunities to
contribute, share opinions and/or feedback, please inform and provide clear instructions to
Young BATU in writing at genevieve_wong@ntuc.org.sg

7. No refund will be payable for non-attendance

DECLARATION

I hereby certify that the information given is to the best of my knowledge and I understand that elements
in the program may be physically and emotionally demanding

I hereby declare that I shall hold blameless and indemnify The Building Construction And Timber Industries
Employees' Union, their employees, the Tournament Committee and appointed officials from any loss, cost,
damage and/or expense of any nature, including all attorneys’ fees and costs which I may have incurred
resulting, either directly or indirectly in my participation in the Young BATU Futsal Tournament.

_________________________________________
Signature of Participant & Date

17