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    Orca Share Media1567494771145

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    marvie borinaga
    This document contains an eligibility form for Joseph Bryan R. Grabillo to participate in intercampus and regional sports competitions in 2019 and 2020. It includes his personal details, medical certification of fitness to participate signed by a physician, an athlete waiver releasing the organizers from liability, and parental consent signed by his guardian.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd

    Orca Share Media1567494771145

    Uploaded by

    marvie borinaga
    22 views1 page
    This document contains an eligibility form for Joseph Bryan R. Grabillo to participate in intercampus and regional sports competitions in 2019 and 2020. It includes his personal details, medical certification of fitness to participate signed by a physician, an athlete waiver releasing the organizers from liability, and parental consent signed by his guardian.

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    orca_share_media1567494771145.xlsx

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    This document contains an eligibility form for Joseph Bryan R. Grabillo to participate in intercampus and regional sports competitions in 2019 and 2020. It includes his personal details, medical certification of fitness to participate signed by a physician, an athlete waiver releasing the organizers from liability, and parental consent signed by his guardian.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    22 views1 page

    Orca Share Media1567494771145

    Uploaded by

    marvie borinaga
    This document contains an eligibility form for Joseph Bryan R. Grabillo to participate in intercampus and regional sports competitions in 2019 and 2020. It includes his personal details, medical certification of fitness to participate signed by a physician, an athlete waiver releasing the organizers from liability, and parental consent signed by his guardian.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 1

    SCUAA Form 3

    INTERCAMPUS/ SCUAA 8 REGIONAL GAMES 2018


    Host: EVSU-ORMOC / Biliran Province State University
    Sept 23-27, 2019/ NOV 27 TO DEC 1, 2019

    Theme:

    ELIGIBILITY FORM

    PARTICIPANT'S PERSONAL INFORMATION


    NAME OF ATHLETE: GRABILLO, JOSEPH BRYAN R. AGE: 22
    DATE OF BIRTH: January 22, 1997 WEIGHT (kg.): 56.5kg HEIGHT (cm.): 5'1"
    BLOOD TYPE: ALLERGIES: N/A Medications (if any): N/A
    ADDRESS: Brgy. Bagong Buhay Ormoc City, Leyte CONTACT NO.: 09676851421
    =======================================================================================================
    MEDICAL CERTIFICATE ATHLETE'S WAIVER & RELEASE AGREEMENT

    This is to certify that: In consideration of the acceptance of my entry, myself, my heirs,


    executors, administrators & assigns, do hereby release & discharge
    JOSEPH BRYAN R. GRABILLO the organizers of the INTERCAMPUS 2019/ SCUAA 8 REGIONAL
    is Physically Fit to participate in the following competitions; GAMES 2019, assisting groups of private or government agencies
    [ ] INTERCAMPUS on Sept 23 to 27, 2019] the Commission of Higher Education and other concerned institutions
    at Eastern Visayas State University, Ormoc Campus respective schools and and officials, and other parties
    [ ] SCUAA REGIONAL GAMES 2019 on Nov 26 to Dec 1, 2019 individual or group, from all claims and damages, demands or
    at Biliran Province State University, Naval Bilitan actions whatsoever in any manner arising from or growing out
    [ ] SCUAA NATIONAL GAMES 2020 of my participation in, or while traveling to and
    from the above-mentioned sports competition. I further attest and
    Blood Pressure: verify that I have obtained the necessary clearance from my medical
    doctor and guaranteed Physically Fit to participate in the said sports
    competition.

    Name and Signature of Physician


    Date of Examination: License No.: Validity Date: JOSEPH BRYAN R. GRABILLO
    Printed Name and Signature of Athlete

    ==========================================================
    ================================
    PARENT/GUARDIAN PERMIT/CONSENT

    This is to certify that I have full knowledge of and permission for my son/daughter/foster child to join and
    participate in the following competitions;
    [ ] INTERCAMPUS 2019 Sept 23 to 27, 2019 at EVSU-ORMOC

    [ ] SCUAA REGIONAL GAMES 2019 on Nov 26 to Dec 1, 2019 at BiPSU, Naval Biliran

    [ ] SCUAA NATIONAL GAMES 2020

    I concur and agree on the rules, policies and regulations being implemented by the concerned organizers.

    MA. FATIMA R. GRABILLO 9979189149


    Printed Name and Signature of Guardian Contact Number
    =======================================
    ============================================================
    ==============================
    SUBCRIBED AND SWORN TO before me this _______________________ in ____________________

    Notary

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