Youth Enrolment Form

Youth Enrolment Form

Are you an outdoor recreation organizer that wants to know the potential medical emergencies and train your staff to be aware and knowledgeable for any circumstance at the events? This template will allow you to collect the information needed from participants. Form Preview
Youth Enrolment Form TEMPLATE
  • Asia Pacific Adventure
  • Youth Enrollment Form

    This information is being collected to enable our staff to more effectively respond to potential medical emergencies. Program participants or their guardians must supply the requested information in order to be able to take part in the program activities. All requested information will be used only for protecting the safety of the participants and will not be shared with others, except as necessary in order to protect participants safety.

    Please note:

    1) Each participant is required to fill in this form for safety management purposes and to deal with incident and emergencies efficiently. All information is strictly CONFIDENTIAL and will be only used for the program's safety management purposes.

    2) Please use ENGLISH to fill in the enrollment form.

    3) The online enrollment form is provided by Jotform.com. Jotform Inc will never sell, share or otherwise distribute your customer's data to third parties. By completing the form means you accept Jotform Inc. Terms of Service and Privacy Policy. For any enquiries, please visit http://www.jotform.com

     

    Declaration

    I, the undersigned (referred as the applicant), declare that the information provided is true and complete. The applicant agrees that the personal data of the applicant may be used by Asia Pacific Adventure(referred as APA) and its staff for administration, programming and emergencies.

    The applicant agrees to abide by the rules for taking part in this program, as well as to participate fully and cooperatively with others while on the course. The applicant understands and accepts that if the rules are not observed, the applicant may be dismissed from the course.

    The applicant understands that the course involves physical activities. To the best of the applicants knowledge, there are no medical or other reasons for the applicant not to take part in this course. The applicant is in normal health with no undeclared pre-existing medical or psychological conditions, or allergies.

    The applicant agrees that while the staff of APA will exercise reasonable care and supervision, neither APA nor its staff, shall be held liable for any loss, damage or injury to person or property occasioned by irresponsible acts or behavior of the applicant.

    The applicant understands that while the staff of APA will exercise reasonable care and supervision, there are elements of risk involved in some of the activities and that APA will not be liable for any injuries or accidents.

    For programs outside of Hong Kong, the applicant is required to have his/her own travel insurance covering evacuation and medical expenses.

    I agree that APA will have the right to use my footage/ images/testimonials in its promotional material or any other materials relating to the program for marketing purposes.

    I understand that the deposit (50% of total program fee) once paid is non-refundable and for cancellation within 2 weeks of the course delivery date, 100% of the total program fee is forfeited. For overseas courses, the applicant has been advised that travel insurance is strongly recommended and the applicant understands that APA will not reimburse for cancellations made for medical reasons. Cancellations due to medical emergencies should be claimed against travel insurance on production of medical certificate. For local courses, full cancellation coverage up to the day of course commencement (on receipt of a doctors certificate) is available through our parent company, APA Group. Please check with your school if you have not already received details.

  • Personal Information

  •  -  - Pick a Date
  • Emergency Contacts

  •  -
  •  -
  • Medical Information

  •  -
  • Administering of non-prescription medications

  • I the undersigned give consent to the Asia Pacific Adventure (APA) staff (First Aid Qualified) to administer the following non-prescription medications to the participant if deemed necessary.

  • APA Free Souvenir

  • Terms and conditions

  • By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

  • Clear
  • Asia Pacific Adventure

    Unit B, 16/F, Gee Chang Hong Centre,

    65 Wong Chuk Hang Road, Hong Kong

    Tel: (852) 2792 7128

  • Should be Empty: