batang pinoy 2014 entry form
TRANSCRIPT
-
8/11/2019 Batang Pinoy 2014 Entry Form
1/2
BATANG PINOY 2014
Previously participated in:
Batang Pinoy 2011 Batang Pinoy 2012 Batang Pinoy 2013
ATHLETE ENTRY FORM
SPORT: LGU/TEAM REPRESENTED:LATEST
2X2
PICTURE
PARTICIPATION INFORMATION
LAST NAME FIRST NAME MIDDLE NAME
GENDER HEIGHT (ft., inch.) BIRTHDATE (mm/dd/yyyy) AGE NATIONALITY
PRESENT ADDRESS:
HOMETOWN:
EMAIL ADDRESS MOBILE NUMBER RESIDENTIAL TELEPHONE NUMBER
SPORTS CLUB AFFILIATION (if any)
I INTEND TO PARTICIPATE IN:
# EVENTS DISCIPLINECATEGORY
AGE WEIGHT (kg)
12
3
4
PREVIOUS COMPETITIONS ATTENDED
(Please indicate Tournament, Date and Place of competition/tournament)
# Name of Competition Date Venue Medals or Awards Received
1
2
3
4
5IN CASE OF EMERGENCY CONTACT:
Emergency Contact Relation CONTACT NUMBER ADDRESS
OTHER INFORMATION
EDUCATIONAL BACKGROUND
LEVEL NAME OF SCHOOL
ELEMENTARY
HIGH SCHOOL
I hereby certify that all the information above is true and correct.
Participant's Signature over Printed Name Coach's Signature over Printed Name
Contact #: ____________________
Tournament Requirements: Registered on:
NSO Birth Certificate_______________
Medical/Waiver Form______________ ID NO:
Checked by:_____________________
-
8/11/2019 Batang Pinoy 2014 Entry Form
2/2
BATANG PINOY 2014
LIABILITY AND MEDICAL RELEASE
I _________________________________, hereby agree to hold the Batang Pinoy 2014
Organizers, their officials, directors or any other person acting on their behalf, free from any
liability, claims or demands in connection with my participation in the Batang Pinoy 2014
(hereinafter called The Tournament)
Furthermore, I agree that should I not have adequate insurance coverage to cover any cost or
expenses that result from my personal injury suffered by me in connection with any activities
associated with The Tournament, I will either acquire such coverage or be personally liable for
any expenses incurred there from.
In emergency cases, I hereby grant permission for Batang Pinoy 2014 Organizers, their
officials, directors or any other person acting on their behalf to seek any medical treatment
they deem necessary for me.
________________________________
Athletes Signature over Printed Name
_______________________________ _______________________
Coach or Delegation Official Signature Date
Contact Information (Very Important):
Name: Father:________________________ Mother:_________________________
Address: ____________________________________________________________
____________________________________________________________
Phone:
Home:______________Office:____________________Cell:___________________
Alternate Contact: Name:__________________________________________
Phone:__________________________________________
Medical Data:
Blood Type:_________________ Allergies:_________________________
Comments:______________________________________________________________