Quirino Hi-way cor. P. dela Cruz St.

, Novaliches, Quezon City

Telefax: 417-3105 email address: rcbn_es@yahoo.com

Official Team Roster

_______________________________________
(School)

Picture Jersey # Name Age Birthdate Year Level

Picture Jersey # Name Age Birthdate Year Level
 Picture Jersey # Name Age Birthdate Year Level

Coach Sports Coordinator Team Uniform Color

Waiver
I hereby certify that the above information are true and correct that all players are properly enrolled. Furthermore, all players listed above are permitted / cleared by
their parent(s)/legal guardian(s) and school officials to participate in RCBN-ES friendly sports tournament.

Signature Over Printed Name of Sports Coordinator Signature Over Printed Name of School Principal
 Quirino Hi-way cor. P. dela Cruz St., Novaliches, Quezon City
Telefax: 417-3105 email address: rcbn_es@yahoo.com

Name: __________________________________________________________
(Last Name) (Given Name) (Middle Name)
2x2 picture
Date of Birth : _______ _______ _______ _______
(mm) (dd) (yyyy) (Age)

Address: _________________________________________________________
____________________________________________________________________________________

Name of School: __________________________________________________ Year level: _________________

STUDENT’S DECLARATION:

I, the undersigned, declare on my honor and to the best of my understanding, that I meet the eligibility
requirements set forth by the Roman Catholic Bishop of Novaliches – Educational System for participation in its sporting
events.
As a RCBN-ES student-athlete, I will uphold the values of fair play, dedication, self-control, team work, discipline
and the spirit of fraternal - friendly competition expected of me and my team at all times while I participate in RCBN-ES
Sports Tournament, and will act in a prudent manner befitting an exemplary student-athlete for the honor and pride of
my alma mater.

______________________________________________ _____________________________________
(Student-Athlete’s Signature Over Printed Name) (Date Signed)

FOR PARENT’S / GUARDIAN’S / WAIVER:

I hereby waive and release the Roman Catholic Bishop of Novaliches – Educational System, Organizing Committee,
________________ (Name of School) and the school venue of this season’s RCBN-ES Sports competitions from any
liability for any and all loss, injury, illness, or damage suffered or sustained by my child / dependent during his / her
participation in the RCBN-ES tournaments. Also, I pledge to conduct myself with calm, cordiality and courtesy in keeping
with the spirit of fraternity and friendship in regard to all sporting events that I may be watching or in which I’ll be
present.
______________________________________________ _____________________________________
(Parent’s / Legal Guardian’s Signature Over Printed Name ) (Date Signed)

- -
Primary Mobile Number Secondary Mobile Number

- -
Home Landline Number Office Landline Number

FOR SCHOOL ADMINISTRATOR

Events to be participated in by Student – Athlete CERTIFICATION:
I hereby certify that all the above information, as well as all
BASKETBALL VOLLEYBALL
other documents submitted about and on behalf of our
___Midget ____ELEM Girls Volleyball
student-athlete are true and correct.
___Aspirant ____HS Girls Volleyball ______________________________________________
___Junior ____HS Boys Volleyball (Sports Coordinator’s Signature Over Printed Name)
___3 x 3 ______________________________________________
(Date Signed)

Approved by: ______________________________

Principal