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APPLICATION KALAHARI VASBYT 2013 NAME.................................................................... SURNAME................................................... NICKNAME.................................. ID NUMBER ........................................................................ DATE OF BIRTH ...................................................... SCHOOL GR IN 2013.......................... EXPECTED SHIRT SIZE IN 2013. Small / medium / large/ x-Large / xx-large .......... EXPECTED SIZE OF PT SHORT IN 2013. Small / medium / large/ x-Large / xx-large .......... NAME OF SCHOOL............................................................................................. APPLICANT'S CELL NO.................................................................................... POSTAL ADDRESS.................................................................................................................. ............................................................................................... POSTAL CODE.......................... TEL NO .................................. TEL CODE .............. FAKS NO.............................................. E-MAIL ........................................................................................................................ PASSPORT NO ........................................................................................................ PASSPORT EXPIRY DATE.................................................................................... (Your passport must be valid until at least 20 July 2013. Namibia only accepts passports that are valid for longer than 6 months. It takes at least three months to get a passport so please apply right away.) SHOULD WE BOOK AN AIR TICKET FOR 1 JAN ON YOUR BEHALF? YES / NO (From Cape Town - Please add an extra amount of R1100 when making your deposit of R1000. From George - Please add an extra amount of R1400 when making your deposit of R1000.) I WILL BE FLYING BACK TO ..................................... ON 18 JAN (Included in price of tour) MEDICAL AID NAME .......................................................... NO .................................................. WHO SUGGESTED THE VASBYT TOUR TO YOU? ............................................................. DETAILS OF PARENT TO CORRESPOND WITH: Title ......................... Name ..................................... Surname ............................................. Cellphone Father ........................................... Mother ........................................................ PARENT'S DECLARATION: I accept the price of the tour as R12 980.00. R1000.00 of this amount is now payable and the difference on 1 December 2012. I accept that the deposit will be wavered if I should cancel for whatever reason. Should I cancel after 1 December 2012, I will be responsible for payment of the full amount of R12 980.00. If the organisers should cancel the tour and I have not withdrawn my application, I would be entitled to a refund of all payment made by me, including the initial deposit. I am aware that my child must be in possession of a valid passport or temporary travel document. I am aware that this is an exhausting adventure course that may hold some elements of danger. I accept that my child will be exposed to dangers such as wild animals and that the tour will be taken at own risk. I am aware that the bush vehicles have limited personal liability insurance and give permission for my child to travel on such a vehicle. I am also aware that my son and some of the other young men attending the course will be allowed to drive these vehicles under strict supervision in the bush. I accept that there are certain risks involved for both passengers and drivers and accept these risks. (There will be no dune driving allowed and no young person will drive under dangerous circumstances. The boys will be given the chance to learn how to drive at low speed in thick sand.) I hereby appoint Mr. Andries J Erwee to act in Loco Parentis from 1 January 2013 to 18 January 2013. He will be responsible for the welfare of abovementioned child. He may grant permission, which may be required by a hospital or medical practitioner, for any medical attention that may be required. Furthermore I appoint Mr. Andries J Erwee to sign any document or to take any action he may deem necessary for the welfare of the abovementioned child. The appointment takes place under condition that he informs me as soon as possible of any serious use of the appointment. Signed: Applicant.....................................................Parent.................................................................. Date.................................... Please fax this form, signed by both the applicant and the parent, to 021 8555764. Include a proof of payment for the deposit. Or post it to: Temba College, PO Box 1515, Somerset West, 7129 Banking Details: FNB; Temba College; Acc No 62083321407; Branch - Somerset West; Branch Code 200512 |
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