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11000-000-4-2006 01\form\Y_W_2006.p10
G U J A R A T U N I V E R S I T YAHMEDABAD.
YOUTH WELFARE DEPARTMENTZONAL/INTER-ZONAL YOUTH FESTIVAL
Name of the College : ............................................................................................Address : ..................................................................................................................................................................................................................................................................................................................... Telephone No. : ..............................Name of the Events : (1) ........................................................................................To Participate (2) .......................................................................................Participant’s Gender (Male/Female) : .....................................................................
Surname Name Father’s/Husband’s Name
1. Name of the Participant : ...........................................................................................................................(In Gujarati)(In English Capitals) : .....................................................................................................................................
2. Date of Birth (In figures) ..................... (In words) ..................................................................................
3. Name of the Faculty of Current Year (Arts/Commerce/Science) ................................... Year ..................
4. College Registration No. ............... OR Current Year Admission Recept No. ........... Date : ...................
5. Information of HSC Equivalent Exam. required for Admission in College :Name of Exam. .............................................. Month/Year of Passing ....................................................
6.Information regarding earlier
Events Year Place ofRankparticapation in Youth Festival Competition
1. At Inter Uni. Level ....................... ........................ ............................. ..................2. At National Level ....................... ........................ ............................. ..................3. State/Uni./Inter Zonal/ ....................... ........................ ............................. ..................
any Other Level7. Residential Address of the Participant : ......................................................................................................
................................................................................................................................................................Contact No. of the Participant : ................................. (Resi.) ................................................ (Mobile)
8. Signature of Student : .............................................................................................................................I certify that the above mentioned information is true according to the best of my knowledge and belief.
Principal’s Sign. College Seal Sign of Prof-in-Charge
Date : ............................ Date : ...........................To be filled by convener
1. Verification of Information : ..........................................................................................................................2. Eligible or Non-eligible : ............................................................................................................................3. Reason for Non-eligiblity : ............................................................................................................................
..........................................Registration Committee Convener
Photostamped andsigned by the
Principal
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13374-20-6-2006 01/form/Y_W_2006.p13
Swami Vivekanand Mountaineering InstituteGaumukh Road, Mount Abu. (Raj.) 307501. Phone & Fax : 02974-235228
Pandit Dindayal Upadhyay Training Centre, Junagadh.
To,
Dear Sir/Madam,As you know being the Institution of Govt. of Gujarat, we organize various courses to train our young ones’
and youths in the field of adventure sports along with nature education. The training is not only induces the spiritof adventure and eco awareness among the youths but also motivate them to follow the path of high moral andthus Nation Building.
Please find enclosed herewith a copy of our course schedule for the year 2006-2007 and an application form,for your perusal.
* You are requested to contact us for the booking of suitable course/courses and their date/dates, in whichyour school, institution or club wish to send participants.
* All guest instructors are also requested to contact and inform the institute for availability of their honoraryservices with suitable date and period of their choice. However the right of selection and allotment of theirduties remains with the institute authority.
Information regarding Courses :* Adventure training Course : This courses is specially design for the young participants’ ageing above
8 years and below 13 years. The purpose is to expose them to the mesmerizing world of nature andadventure. The duration of course is 7 days. Activities like primary rock climbing, caving, trekking, birdwatching, star gazing, artificial and natural obstacle crossing, eco awareness and night camping are beingimparted practically and thcoretically to the participants with utmost safety.
* Basic Rock Climbing Course : The duration of course is 10 days and is designed to train the youthsageing above 13 years in area of serious rock climbing. Focus of the training is to impart the basic skillsof rock climbing, knowledge of knots, trekking, night trekking, camping, nature education, physical fitnessand discipline.
* Advance Rock Climbing Course : This 15 days training course is designed for those who hadsuccessfully completed the basic rock climbing course with good grading and are interested to avail furtherknowledge in the same area as described in basic rock climbing course training along with basics of mapreading (navigation).
* Coaching rock Climbing Course : This 30 days training course is only designed for the participantsthose who had successfully completed advance rock climbing course with good grading and are interestedto become Instructor in this field or to become a serious mountaineer.
* Artificial Rock Climbing course : This 10 days training course is designed to train instructors in thecertain specialized techniques of rock climbing, rope work and rescue methods.
Arrangement of hostel facility and training are provided free of cost by Govt. Participants or club/institution/school have to born the food expenses. This year Rs. 60/- head/day will be charged as per the norms decidedby Govt. of Gujarat.
Our certificate carries special value for those who prefer to choose the job in the armed forces, paramilitaryand police department.
14374-20-6-2006 01/form/Y_W_2006.pmd
Swami Vivekanand Mountaineering InstituteGaumukh Road, Mount Abu. (Raj.) 307501. Phone & Fax : 02974-235228, 237103
Pandit Dindayal Upadhyay Training CentreRadhanagar Society, Garnar Darwaja, Junagadh 362001. Phone : 0285-2627228
SECOND TERM TIME TABLE FOR TRAINING COURSES-2006-07
Adventure Training Courses. (for 8 to 13 Years Old Kids)
No. Date Name of Course Duration Remarks
8. 04-10-2006 to 10-10-2006 Adventure Training Course 7 Days Govt. Exp.9. 13-10-2006 to 19-10-2006 Adventure Training Course 7 Days10. 26-10-2006 to 01-11-2006 Adventure Training Course 7 Days11. 03-11-2006 to 09-11-2006 Adventure Training Course 7 Days12. 13-11-2006 to 19-11-2006 Adventure Training Course 7 Days13. 21-11-2006 to 27-11-2006 Adventure Training Course 7 Days14. 29-11-2006 to 05-12-2006 Adventure Training Course 7 Days15. 07-12-2006 to 13-12-2006 Adventure Training Course 7 Days16. 15-12-2006 to 21-12-2006 Adventure Training Course 7 Days17. 23-12-2006 to 30-12-2006 Adventure Training Course 7 Days18. 06-01-2007 to 12-01-2007 Adventure Training Course 7 Days19. 16-01-2007 to 22-01-2007 Adventure Training Course 7 Days20. 05-02-2007 to 11-02-2007 Adventure Training Course 7 Days
Basic Rock Climbing Courses, (for 14 to 45 Years Participants)
No. Date Name of Course Duration Remarks
8. 21-09-2006 to 30-09-2006 Basic Rock Climbing Course 10 Days9. 04-10-2006 to 13-10-2006 Basic Rock Climbing Course 10 Days10. 26-10-2006 to 04-11-2006 Basic Rock Climbing Course 10 Days11. 07-11-2006 to 16-11-2006 Basic Rock Climbing Course 10 Days For Girls12. 20-11-2006 to 29-11-2006 Basic Rock Climbing Course 10 Days13. 05-12-2006 to 14-12-2006 Basic Rock Climbing Course 10 Days14. 21-12-2006 to 30-12-2006 Basic Rock Climbing Course 10 Days For Girls15. 03-01-2006 to 12-01-2007 Basic Rock Climbing Course 10 Days16. 16-01-2007 to 25-01-2007 Basic Rock Climbing Course 10 Days17. 29-01-2007 to 07-02-2007 Basic Rock Climbing Course 10 Days18. 13-02-2007 to 22-02-2007 Basic Rock Climbing Course 10 Days
Advance (for 15 to 45 Years Participants) & Coaching (16 to 45 Years Participants) Rock Climbing Courses
No. Date Name of Course Duration Remarks
4. 04-10-2006 to 18-10-2006 Advance Rock Climbing Course 15 Days5. 26-10-2006 to 09-11-2006 Advance Rock Climbing Course 15 Days6. 16-11-2006 to 30-11-2006 Advance Rock Climbing Course 15 Days Govt. Exp.7. 01-12-2006 to 15-12-2006 Advance Rock Climbing Course 15 Days8. 17-12-2006 to 31-12-2006 Advance Rock Climbing Course 15 Days1. 05-02-2007 to 14-02-2007 Refresher Course for Instructors 10 Days Govt. Exp.2. 01-11-2006 to 30-11-2006 Coaching Rock Climbing Course 30 Days Govt. Exp.1. 01-02-2007 to 10-02-2007 Trekking in Gujarat’s Mountains 10 Days Govt. Exp.1. 04-10-2006 to 18-10-2006 Trekking in Himalayan Ranges 15 Days Govt. Exp.1. 05-02-2007 to 14-02-2007 Artificial Rock Climbing Course 10 Days Govt. Exp.
15Govt. of Gujarat
Swami Vivekanand Mountaineering InstituteGaumukh Road, Mount Abu. (Raj.) 307501. Phone & Fax : 02974-235228, 237103
Pandit Dindayal Upadhyay Training CentreRadhanagar Society, Girnar Darwaja, Junagadh 362001. Phone : 0285-2627228
Application Form1. Name of the Applicant : ....................................................................................
(write in capital letter with your surname first)
2. Full Address : ....................................................................................
....................................................................................
....................................................................................
Tel. No with STD code : ....................................................
3. Date of Birth : ....................................................................................
(Attach Certificate) (Date) (Month) (Year)
4. Educational Qualification : ....................................................................................
If student! School/College Name : ....................................................................................
5. Have you participated in any sports : 1 ..................................................................................2 ...................................................................................3 ..................................................................................
6. Name of the course you are applying for ? : ....................................................................................
Starting from the date : - -200
(If you are applying for Advance/Coaching/Artificial Rock climbing course, attach all previous rock climbing course certificate’s copies, that you have done successfully)
7. Are you physically & mentally fit to undergo such
adventurous training? : (if yes, Please Attach Medical fitness .....................................(Yes/No)
Certificate duly filled up & examined by any R.M.o./R.M.P/Physician) :
8. Are you a resident of Gujarat State? : .....................................(Yes/No)
(if yes, Please attach copy of ration card or a copy of domicile certificate)
9. Mention if any experience of trekking or hiking : 1 ......................................................................2......................................................................
10. I the under sign, intend to join this training course at my own ‘Will’, cost and risk. I know that thistype of training requires tremendous commitment and discipline both physically and mentally, I alsoknow that it involves life threatening risk and in that case I or my family will not held the Govern-ment, the Institution or its staff responsible. I also undertake to abide by the rules and regulations ofthe Institution, failing to which may result in my expulsion from the course.
.................................................
(Signature of the applicant)
[P.T.O.
16Medical Fitness Certificate[To be filled by R.M.O./R.M.P./Phyiscian]
1. Name of the participant : ........................................................................2. Age : ........................................................................3. Hight (ft.inch) : ................................. ft & ............................inch4. Weight (kg.) : .................................................................... kg.5. Is he/she suffering from any Coronary diseases : ........................................................................6. Is he/she suffering from any Pulmonary diseases : ........................................................................7. Is he/she suffering from any Vision related diseases : ........................................................................8. Is he/she suffering from any Psychological diseases : ........................................................................9. Is he/she suffering from any bone diseases : ........................................................................10. Please mention any serious injury in recent past : ........................................................................
This is to certify that Mr./Ms. .................................................................................................. is physicallyand mentally found fit on his/her examination, to undergo any adventurous or mountaineering trainning activities.
Place : Signature of Doctor
Date : with stamp and Reg. No.
RISK CERTIFICATE
(To be filled and signed by Parent/Guardian, in case the applicant is below 18 years of age)
I the under signed, namely Mr./Ms. .................................................................................................. father/mother/guardian of Mr./Ms. ......................................................................, hereby giving my consent to my son/daughter to join and undergo the Adventure training course or the Rock climbing training course conducted bySwami Vivekananda Institute of Mountaineering/Pandit Dindayal Upadhyay Training Centre I’m fully aware of thedanger involved during this kind of training camp and if my son/daughter meets with an accident-’fetal or otherwise’during the entire training course, I shall not hold the Government, the Institute or its staff liable or responsible for thesame. I also agree and accept that my son/daughter has to and will be abide by the rules and regulations of yourInstitute, failing to which may result in his/her expulsion from the training course without notice.
.............................................................Place : Signature of Parent/Guardian
Date : Tel. No. with STD Code : ...........................
17Ì212-500-5-2006 01\Form\Y_W_2006p12
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Every student admitted to an affiliated college recognised institution and University department shall pay feeof Rs. 20/- per term towards the expenses for organising cultural activities in the University, out of which Rs.10/- per student shall be remitted to the University by the college/institution/University department within onemonth from the date of commenced of the term. The amount shall be used by the University towards theexpenditure incurred in the organisation on the cultural activities of the University students community andremaining amount Rs.10/- per student per term can be retained and shall be used by the college/institution/University department for promaotion of the cultural activities of the respective college/institution/Universitydepartment.
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