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IIT KGP Student Trek Registration

This document is a student registration form for a Kedarkantha Trek being organized by the Technology Students' Gymkhana (TSG) at the Indian Institute of Technology Kharagpur. The form collects information such as the student's name, date of birth, contact details, medical history, and current medical condition as certified by a medical practitioner. Both the student and their parent must declare that the student is medically fit for the activity and will not hold the organizers responsible in case of any health issues. They also agree to follow the rules laid out by the institute and organizers during the activity.

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Kavin
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99 views1 page

IIT KGP Student Trek Registration

This document is a student registration form for a Kedarkantha Trek being organized by the Technology Students' Gymkhana (TSG) at the Indian Institute of Technology Kharagpur. The form collects information such as the student's name, date of birth, contact details, medical history, and current medical condition as certified by a medical practitioner. Both the student and their parent must declare that the student is medically fit for the activity and will not hold the organizers responsible in case of any health issues. They also agree to follow the rules laid out by the institute and organizers during the activity.

Uploaded by

Kavin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

INDIAN INSTITUTE OF TECHNOLOGY KHARAGPUR

Technology Students’ Gymkhana

Student Registration Form (Intramural/Extramural)


Activity: Kedarkantha Trek being organized by TAdS
Name of Student Roll No

Date of Birth Age as on Date Yrs Mths

Father’s Name Mother’s Name

Contact No. Alt. Contact No.

Email (Self) Email (Parent)

Home Address Address at IIT


KGP

Medical History Present Medical


Height: Weight:
(if any) Condition
(To be Certified by BP: Respiration:
a Registered
Medical
Physical Deformity (if any)
Practitioner)

Any Other:

Final Observation: Fit/Unfit

Signature of Student with Date


Signature with Seal

Declaration • I agree to be disciplined and follow the rules and Declaration • I agree to my son/ daughter taking part in the
(Self) regulations laid by the Institute/Authority. (Parent) activities of the program.
• I confirm to the best of my knowledge that I am • I confirm to the best of my knowledge that
Medically Fit for the activity and will not hold my son/ daughter is fit and does not suffer from
any one responsible if I suffer from any disease or any medical condition.
other ill health condition. • I understand and agree that the organizers
• The Institute/Authority will have full right to will do their best for the safety & smooth
Suspend/Pre-pone/Postpone the activity without conduction of the activity, still in case of any
any prior notice w.r.t. the circumstances. unnatural happening, I will not hold anyperson(s)
• I understand and agree that the organizers will do of TSG or TSG or IIT Kharagpur responsible.
their best for the safety & smooth conduction of the
activity, still in case of any unnatural happening, I
will not hold any person(s) of TSG or TSG or IIT
Kharagpur responsible.

Full Signature with Date Full Signature with Date

Full Signature of Student with Date

Sr. Sports Officer

President, TSG Full Signature of in-charge with Date

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