Republic of the Philippines

Jose Rizal Memorial State University

The Premier University in Zamboanga del Norte
Main Campus, Dapitan City

SUPREME STUDENT GOVERNMENT

9th INTERCOLLEGIATE STUDENTS’ FESTIVAL

COMPETITOR’S ELIGIBILITY FORM

College/Department:___________________________________ Sport/Event:_________________
Name of Competitor: __________________________________ Date of Birth: _______________
(Given Name) (M.I.) (Family Name)
Permanent Address: _______________________________________________________________
Place of Birth: _____________________Age: ____ Gender:___ Contact Number:______________
In case of emergency, please contact /notify:
____________________ _____________________________ ________________________
(Name) (Address) (Contact No.)

______________________________
Name of Student
Attested: (Signature over Printed Name)
________________________
Coach
(Signature over Printed Name)

N.B. Please attach in this form the following documents:

(1) Photocopy of the validated Student’s Copy
(2) Photocopy of Validated School ID
(3) Parent’s Consent and Waiver

MEDICAL CERTIFICATE FORM

TO WHOM IT MAY CONCERN:

This is to certify that ____________________________________________has been
(Name of Player/Performer)
examined physically and found to be fit to participate in the 9 th INTERCOLLEGIATE STUDENTS’
FESTIVAL to be held on October 23 – 26, 2019 at Jose Rizal Memorial State University, Main
Campus, Dapitan City.

BP: _________________________
Height: ______________________
Weight: _____________________
Pulse Rate: ___________________
SpO2: ______________________
_______________________________
Medical Consultant