RESTRICTED

STAFF – IN – CONFIDENCE

To: Heartware Network

UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT FORM

(To be completed by ALL volunteers)

Undertaking

I hereby undertake to comply with all of the conditions, guidelines and regulations as set out by Heartware Network,
the sponsors, the various co-organisers and volunteer leaders.

I hereby undertake to attend all the training sessions as scheduled by the Executive Committee and understand that
I shall not be eligible for the full benefits should I be absent for more than 2 sessions without valid reasons**.

Acknowledgement of Risks

I , holder of *NRIC/Passport No. , am fully aware that my participation in

“Chingay Ushers 2011” and all related trainings and activities from the date, 11 December 2010 to 12
February 2011 (inclusive) involves certain amount of risk(s).

I acknowledge that I am voluntarily participating in this event and its related trainings and activities and with
knowledge of such possible risk(s).

I hereby undertake that I shall not hold the event organisers, their sponsors and their respective officers,
representatives, employees, volunteers and agents for any loss or damage or any injury which may be sustained by
me (including loss of life) during the event or arising from any cause in connection with the event howsoever the
same may be caused. However, the organiser shall, to the best of its ability, take precaution and put in place safety
measures to avoid such occurrences.

I further declare and confirm that I have read and fully understood all the sections in this form including the
preceding acknowledgement and undertaking and all the information provided herein are true.

Name & NRIC No. of Participant Signature of Participant Date

* Please delete where appropriate.

** All excuses must be accompanied by an official MC or excuse letter. Heartware Network reserves the right to deicide the validity of the
reasons provided.

Volunteers
STAFF – IN – CONFIDENCE
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 RESTRICTED
STAFF – IN – CONFIDENCE

CONSENT FORM
(To be completed by parent or legal guardian of participant under 21 years)

Consent

I, , holder of *NRIC/Passport No. give consent for my *child/ward

, holder of *NRIC/Passport No. to attend the event, “Chingay Ushers 2011” and all related trainings
and activities for the duration from 11 December 2010 to 12 February 2011 (inclusive).

I am aware that my child’s/ward’s participation in the event involves certain amount of risk(s). I acknowledge that I
am allowing my child/ward to participate in the event voluntarily and with the informed knowledge that there are
risks involved.

I understand that he/she will have to co-operate fully with Heartware Network, sponsors, organisers and leaders of
the event and comply with conditions, guidelines and regulations as set out by the event organisers and team
leaders.

I hereby undertake that I shall not hold the organisers, their sponsors and their respective officers, representatives,
employees, volunteers and agents for any loss or damage or any injury or illness which may be sustained by my
*child/ward (including loss of life) arising from any cause in connection with the event howsoever the same may be
caused. The organiser shall, to the best of its ability, take precaution and put in place safety measures to avoid such
occurrences.

I fully declare and confirm that I have read and fully understand all the sections in this event consent form
including the preceding acknowledgements and undertaking and ensure that my child/ward fully
understands the same and that all the information provided herein are true.

Name & NRIC No. of *Parent / Guardian Signature of *Parent / Guardian Date

* Please delete where appropriate.

Volunteers
STAFF – IN – CONFIDENCE
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