OFFICIAL REGISTRATION FORM : International Seminar, Scrabble and Chess Olympiad (ISSCO) in ASEAN Youth Camp MALAYSIA 2019

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Please fill in the form for EACH participant.
Click https://goo.gl/7quRu6 to check your registration status.

Please visit https://www.sciencejohor.com and https://www.aeisa.org for more information an inquiries.
Your early response much appreciated

First and foremost, Please fill in Teacher's Email address below, and we will send the copy of Registration form for your perusals.

Email *

1.0 Nationality *

2.0 School's / Institution's Name *

2.1 School Phone Number

2.2 School's email address *

2.3 School's website / portal *

3.0 Position *

4.0 Male @ Female *

5.0 Participant's Passport Number *

5.1 Full Name and same as stated in Passport *

5.2 Passport Expiration Date *

YYYY

6.0 My general state of health is: *

6.1 Special Dietary *

Vegetarian

Normal Consumers

Any Food Allergy

6.1.1 If YES, Please provide details

6.2 My level of fitness is : *

High

Medium

Low

6.3 Are you taking medication ? *

6.3.1 If YES, please specify :

6.4 Have you been hospitalized in the past 12 months ? *

YES

6.4.1 If YES, please provide details :

6.5 Do you suffered from any of following condition or disorders? *

Chest pain, High blood pressure and other heart problem

Asthma, Bronchitis, tuberculosis, Sinusitis and othe lung problems

Fits , Epilepsy , Fainting spells ,Migraine , Severe head injury

Eye problem /Poor vision

Allergy to medicines / Deafness

Nervous illness

Diabetes

Bone or joint injury , Back disorder

Muscular damage or strain

Phobias

Blood disorders

A carrier status for any infectious

Other recent illness

I am healthy

Required

7.0 Declaration and consent *

I declared that my Parent / guardian give permission to me to attend the camp as stated in my school documents

Required

7.1 Declaration and Indemnity Form *

I hereby declare that I will not hold ASEAN Youth Camp Malaysia 2019, Organizing Team , its agents and Co-host Schools responsible for any damage to or loss of personal property or any injuries sustained by my child during the programme . I certify that the information provided is true and comprehensive.

Required

7.2 Medical and Emergency Information *

I authorize ASEAN Youth Camp Malaysia 2019, Organizing Team, its agents and Co-host Schools to obtain assistance when they deem necessary in the event or any illness or accident suffered by my child . I agree to pay for any medical and emergency transport services incurred on her behalf.

Required

7.3 Medical and Emergency Information *

I hereby declare that all the medical information provided is accurate. I understand that my child comfort and safety may be dependent on him /her bringing the stipulated equipment and exercising good judgment whilst participating in all activities

Required

7.4 Medical Expenses and Reimbursement *

I further understand ASEAN Youth Camp Malaysia 2019 shall not be held responsible for any expenses arising from any medical consultation or treatment for any injuries or illnesses , including but not limited to fever, flu/cold ,cough ,gastric problems , diarrhea , etc . Such medical expenses and transport expenses shall be at our own expense , and TAYC shall be fully reimbursed by us for any amount paid for

Required

8.0 Arriving Airport *

8.1 Date and Time of Arrival *

YYYY

Time

8.2 Departing Airport *

8.3 Date and Time of Departure *

YYYY

Time

9.0 Payment reference number (Telegraphic Transfer Receipt) *

9.1 Date of Payment *

YYYY

Time

10.1 Shirt design *

10.2 Shirt Size

A copy of your responses will be emailed to the address you provided.

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