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Holiday Program by Alexandra Hospital

Name: Holiday Program by Alexandra Hospital
Start: 2018-12-17T00:00:00+08:00
End: 2018-12-17T23:59:59+08:00
Location: Alexandra Hospital

December 17, 2018

Registration

Little Medical School 17 Dec 2018 (9am - 12pm) for kids aged (4 to 12).

I give my child permission to participate in the Little Medical School Singapore program.

Please make payment by Bank Transfer or Cheque payable to Inspiring Generations Pte Ltd. Please indicate student name for reference during payment.

Bank details as follows: Inspiring Generations Pte Ltd. Malayan Banking Berhad Singapore Account number: 040-1154-7140
31 May - 1 June 2021*
- Little Medical School (10am - 1pm)
In the event of non attendance, there will be no refund of Program Fees. Program materials will be given back to each participant.
PROMO CODE (If any)
Name of Child*
First Last
Age*
Please enter a number from 1 to 15.
Date of Birth*

Day
Month
Year
Address*
Street Address ZIP / Postal Code Country
List any allergies or medical history that may be of importance
*In case of an emergency involving my child, I give permission for the Little Medical School Program staff to seek emergency medical treatment for my child and to act as guardian in permitting medical treatment if unable to reach me. I understand that all emergency and/or medical costs are my responsibility.
Parent/Guardian's Name*
First Last
Relationship*
Phone Contact Number*
Contact Number 2 (Optional)
Email*
WAIVER OF LIABILITY
 This agreement releases Inspiring Generations Pte Ltd (Little Medical School Singapore) from all liability relating to injuries or allergies that may occur by using a stethoscope, mortal pestle, blood pressure cuff, or any equipment used in particular classes. By signing this agreement, I agree to hold Inspiring Generations Pte Ltd (Little Medical School Singapore) entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence.
Please select:*
- I Accept
- I Decline
USE OF STETHOSCOPE
  I acknowledge the risks involved in using a stethoscope. These include but are not limited to ear infections, blown ear drums, wrapping stethoscope around neck, and yanking of stethoscope causing injury. I swear that I am participating voluntarily, and that all risks have been made clear to me. Additionally, I do not have any conditions that will increase my likelihood of experiencing injuries while engaging in this activity.
By signing below I forfeit all rights to bring a lawsuit against Inspiring Generations Pte Ltd (Little Medical School Singapore) for any reason. In return, I will receive a stethoscope. I will also make every effort to obey safety precautions as listed in writing and as explained to me verbally. I will ask for clarification when needed.
Please Select:
- I Accept
- I Decline
CONSENT TO PHOTOGRAPH, INTERVIEW, AND/OR AUTHORIZE THE RELEASE OF INFORMATION
I consent and authorise to take photographs, video, or other visual images of me and/or my child and/or to record me and/or my child’s voice, the results of which may be published into the public domain in print, visual, or electronic media including, but not limited to: brochures, direct mail, advertisements, newspapers, newsletters, magazines, television, radio, presentations, web sites, and trade show displays. I understand that the visual images or audio recordings may make me and/or my child’s identity recognisable.
I agree that all reproduction and all copyrights associated with the above described media shall remain the property of Inspiring Generations Pte Ltd (Little Medical School Singapore). I understand that the use of the communications efforts may directly or indirectly benefit the program financially.
I agree that my child and/or I are not entitled and release any right to any claim my child and/or I may have related to use of my and/or my child’s visual images and/or audio recordings, including but not limited to, any claim for payment or royalty in connection with distribution or publication of these communications.
I understand that I have the right to revoke this authorisation in writing at any time by written request to Inspiring Generations Pte Ltd (Little Medical School Singapore). But the revocation will not be effective to the extent that releases Inspiring Generations Pte Ltd (Little Medical School Singapore) already relied on my authorisation; for example, the revocation will not apply to publications already in production nor will it apply to publications already distributed to the public. Otherwise, the authorisation will remain in effect for 5 years or until the media utilizing the photograph(s) or interviews are no longer in use, whichever occurs later.
My choosing of "I Accept" below evidences my voluntary consent and authorization for the publication of visual images and/or audio recordings of me and/or my child by Inspiring Generations Pte Ltd (Little Medical School Singapore).
Please Select:
- I Accept
- I Decline
Name of Participants
Please add here if you have more than one child taking part in the same program. Each Participant are subjected to the same Waiver of Liability, Consent to Photograph, Interview, and/or Authorise the release of Information.
Name
First Last
Date of Birth
Month
Day
Year
Name
First Last
Date of Birth
Month
Day
Year
Name
First Last
Date of Birth
Month
Day
Year
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Details

Date:: December 17, 2018

Venue

Alexandra Hospital

378 Alexandra Rd, Singapore 159964 159964 Singapore + Google Map

Holiday Program by Alexandra Hospital

Holiday Program by Alexandra Hospital

December 17, 2018

Registration

WAIVER OF LIABILITY

USE OF STETHOSCOPE

CONSENT TO PHOTOGRAPH, INTERVIEW, AND/OR AUTHORIZE THE RELEASE OF INFORMATION

Name of Participants

Details

Venue