Individual Sign Up | Everesting For Second Chances

Registration Form

Thank you for your interest in joining Everesting For Second Chances.
Before you register, please take some time to go through the details.

Registration fee is not tax deductible.

Please fill in your details in the following form:
Required fields are denoted by *.

Account Details

Everesting Challenge *

Enter Promo/Corporate Code (If any)

Tip: Promo/Corporate Codes are issued by Event Organiser.

My Email Address (Your Login ID) *

Make sure your email address is correct. Event updates and instructions will also be sent there.

Confirm Email Address *

My Account Password *

Confirm Account Password *

My Account Display Name *

My Account Tagline

My Preferred T-Shirt Size *

Click here to view size chart.

My Display Photo

Upload the photo in JPG or JPEG format with a maximum size of 8MB size. The recommended ratio is 1:1 with minimum image width and height of 250px by 250px.
Note that uploaded image will be automatically square cropped.

My Target Fundraising Amount *

Please indicate the amount (SGD) *

$ .00

I got to know about this event through... *

Please specify *

Personal Particulars

Full Name (as per NRIC/FIN/Passport No.) *

Mobile Number *

Date of Birth *

Sex *

Occupation

Industry

Emergency Contact

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Mobile Number *

Medical History

Blood Group *

Allergies (If any, put NIL if not applicable) *

Medical Conditions (If any, put NIL if not applicable) *

Collection / Delivery of Entitlements

*Method for collection of the entitlements

Country

Postal Code *

Unit Number *

Please indicate NA if there is no unit number.

Building Number *

Street Name *

Building Name

Parental/Guardian Consent

I, the parent/guardian of the participant, has read the rules and regulations of the event and allow the participant to sign up and take part in this event. I shall not hold the organiser, its officers, staff, volunteers, agents, contractors, event officials, event sponsors and event partners from all and any demands, claims, liabilities, proceedings, suits, losses and/or damages of any kind whatsoever arising out of or in connection with his/her participation in the event, including without limitation, personal injury and/or death.

Parent/Guardian's Name *

Parent/Guardian's Contact Number *

Health Declaration

I do not have any medical condition that would affect my safety or physical wellbeing. I am medically and physically fit and competent to participate in the Event. I fully understand and acknowledge the risks involved in my participation in the Event and I accept full responsibility and agree to solely assume all such risks.

Terms and Conditions

I have read and agree with the above stipulated Terms and Conditions.

PDPA Consent

I consent to and allow the Organiser to collect, use, disclose and/or process my personal data in order to process, administer, facilitate, maintain and/or manage my relationship with the Organiser as a member, volunteer, programme participant, beneficiary and/or donor (“Purpose”), including communications on the Organiser’s activities, programmes and services; donation requests; carrying out research, analysis and development activities for the Organiser’s purposes; and making disclosures required by law or a competent authority. The Organiser may, for the above Purpose, disclose my personal data to its third party service providers and/or agents, which may be sited outside of Singapore (subject always to requirements under applicable law having been met).

In any event, I acknowledge that the Organiser may send communications on its activities, programmes and services to me via email and/or post.

If I do not wish to receive such communications via email and/or post, or if I wish to make changes to consent previously given, I understand that I may opt out by writing to the following email address everesting@hcsa.org.sg.

Payment

Total Amount (Inclusive GST)

$68.00