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    Form A1 A3 - Merged

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    Ezekiel Marino

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    Form A1 A3 - Merged

    Uploaded by

    Ezekiel Marino
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    Form-A1-A3_Merged (1)

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    6 views3 pages

    Form A1 A3 - Merged

    Uploaded by

    Ezekiel Marino

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    PHILIPPINE ROTC GAMES 2024

    “Husay ng ROTC, Husay ng Kabataan”


    Form A1 – Athletes Profile

    __________________
    SPORTS
    __________________
    EVENT/WEIGHT CATEGORY

    Qualifying Leg: ▢ Luzon ▢ Visayas ▢ Mindanao


    Branch of Service: ▢ Air Force ▢ Army ▢ Navy

    A. PERSONAL DATA

    Name: ___________________________________________________________________________
    Last Name First Name Middle Name Name Extension
    Birthday: ___________________ Age: __________ Birthplace: ___________________
    Sex: _________ Insurance Type: _______________ Insurance No.: ________________
    Course: _______________________________________ Contact No.: __________________
    School (Don’t abbreviate):
    __________________________________________________________________________________
    School Address: ___________________________________________________________________

    Currently/Formerly GAB/National Athlete: ▢ Yes ▢ No

    In case of emergency:
    Contact Person: _____________________________ Contact Number: _______________________
    Relationship: _________________________________________

    ______________________
    Athlete’s Signature

    ***NOTE: Please attach your BIRTH CERTIFICATE and CERTIFICATE


    OF ENROLLMENT/REGISTRATION (AY 2023-2024) at the very last
    page to complete your requirements.

    By answering this Form, I hereby express my consent for the members of the PRG Executive Organizing Committee to collect,
    record, organize, update or modify, retrieve, consult, use, consolidate, block, erase or destruct and share my personal data
    collected herein to the Offices in the House of Representatives and Senate of the Philippines, and be indemnified in case of
    damages pursuant to the provisions of the Republic Act No. 10173 of the Philippines, Data Privacy Act of 2012 and its
    corresponding Implementing Rules and Regulations.
    PHILIPPINE ROTC GAMES 2024
    “Husay ng ROTC, Husay ng Kabataan”
    Form A2 – Medical Certification

    __________________
    SCHOOL
    __________________
    CITY / MUNICIPALITY - REGION
    __________________
    SPORTS
    __________________
    EVENT/WEIGHT CATEGORY

    MEDICAL CERTIFICATE

    ___________________
    Date

    To Whom It May Concern:

    This is to certify that I have personally examined ___________________________________,


    age _____, sex ________, born on ______________, and have found that he/she is physically
    fit to participate in the Philippine ROTC Games 2024.

    Physical Examination

    Date examined: _____________

    Height (m): ____________ Weight(kg): ____________ Blood Pressure: ________________


    Pulse, Resting: _____________ Respiratory Rate: ______________
    Other:_____________________________________________________________________
    Remarks:
    __________________________________________________________________________
    __________________________________________________________________________

    _____________________________
    Physician/Medical Officer
    (Signature over printed name)

    License No.: __________________


    PTR: _________________________
    License Expiry Date: ____________

    By answering this Form, I hereby express my consent for the members of the PRG Executive Organizing Committee to collect,
    record, organize, update or modify, retrieve, consult, use, consolidate, block, erase or destruct and share my personal data
    collected herein to the Offices in the House of Representatives and Senate of the Philippines, and be indemnified in case of
    damages pursuant to the provisions of the Republic Act No. 10173 of the Philippines, Data Privacy Act of 2012 and its
    corresponding Implementing Rules and Regulations.
    PHILIPPINE ROTC GAMES 2024
    “Husay ng ROTC, Husay ng Kabataan”
    Form A3 – Parental Consent

    __________________
    SCHOOL
    __________________
    CITY/MUNICIPALITY - REGION

    PARENTAL CONSENT

    I/ We hereby willingly and voluntarily give consent to the participation of my/our


    son or daughter _______________________________in the Philippines ROTC Games 2024.
    (Name)

    I/We have considered the benefits that my/our son or daughter will derive from his or her
    participation in this activity, provided that due care and precaution will be observed to ensure
    the comfort and safety of my son or daughter.

    Furthermore, should my son/daughter have no existing insurance coverage, I/We agree that
    I/We shall acquire such insurance to cover personal injuries that my/our son/daughter may
    incur during the events. Otherwise, I/We will be personally liable for such expenses incurred
    therefrom.

    In emergency cases, I/we hereby grant permission for the PRG 2024 Executive Organizing
    Committee or any person acting on their behalf to seek any medical treatment they deem
    necessary for my son or daughter.

    ___________________________________________
    Father/Mother/Guardian
    Signature Over Printed Name

    By answering this Form, I hereby express my consent for the members of the PRG Executive Organizing Committee to collect,
    record, organize, update or modify, retrieve, consult, use, consolidate, block, erase or destruct and share my personal data
    collected herein to the Offices in the House of Representatives and Senate of the Philippines, and be indemnified in case of
    damages pursuant to the provisions of the Republic Act No. 10173 of the Philippines, Data Privacy Act of 2012 and its
    corresponding Implementing Rules and Regulations.

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