Neelakurinji Flower Valley & Galikere Trek, SEP/OCT22 - Nisarga Registration Form
Congrats for taking your first step towards being part of NISARGA Family..!

All Participants need to Fill Up this form and make the payment before being shortlisted for the Program. Please note that filling up this form does not guarantee your participation. Participation is based on availability of slots and is considered on First Come - First Serve basis only. All questions marked * are mandatory. Team Nisarga takes utmost care not to reveal any of your personal details.

Nisarga has active presence on Facebook & Instagram:
- https://www.facebook.com/NisargaOutdoors/
- https://www.instagram.com/NisargaOutdoors/

For Refund & Cancellation Policy, see here: https://www.facebook.com/notes/nisarga/nisarga-cancellation-refund-policy/549394475124773

Visit our website - www.nisargaoutdoors.com and subscribe to nisarga community for email notifications
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Your Name *
Please Give us your full name
Gender *
eMail ID *
Please give us the correct email ID. All our correspondence will be primarily through this
Mobile Number *
In this format +91 123456789. Don't worry, We won't be sharing this with anybody else in the trek!
Emergency Contact Number *
Please provide the number of someone close (Parent/Guardian/Spouse/Sibling/Friend) whom we can call in case of emergency
Age in Years
Take the closest birthday into account
How you got to know about this program? *
please let us know the name of the person referred by or the media (like FB, Twitter, Website name etc) where you came across the event
Have you ever gone on a trek / adventure camp / activity before? *
Are you Covid19 vaccinated? *
Blood Group *
In case you don't know / don't remember we strongly recommended that you get it tested before start of the trek.
Nisarga aims to build a database of Blood Groups to be able to help those in need. Would you like us to contact you when required? *
Answer YES if you think this makes a difference and you would want to volunteer.
Are you allergic to any medicine? If so, please mention all the ones you can recall, else leave blank
Residential Area *
eg. Vijayanagar, Bangalore. This will help us plan our pickups & drops better.
1.    I acknowledge the existence of risks and accept ALL RISKS, KNOWN AND UNKNOWN whether before, during or after this activity. These risks may include, but not limited to, loss or damage to personal property, physical injury, mental injury, paralysis, death, road accidents, accident or illness in remote places without medical facilities, potential dangers of exposure to weather, potential flulike symptoms from trekking in mist and rain, surface hazards, equipment failure, inadequate safety practices/equipment, arrests for trespassing or other violations, the dangers arising from potential animal attacks, the hazards of walking on uneven terrain and slips and falls; the forces of nature, including lightning and rapid weather changes; the risk of exposure to insect bites; the risk of cold including hypothermia; my own physical condition, and the physical exertion associated with this activity. I expressly agree and promise to accept and assume all of the risks existing in this activity. *
My participation in this activity is purely voluntary, and I choose to participate in spite of the risks.
2. I have had sufficient opportunity to read this entire form. I have read and understood it, and I agree to be bound by its Terms & Conditions *
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