8/11/2019 Batang Pinoy 2014 Entry Form

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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

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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:______________________________________________________________