ORMOC BASKETBALL COACHES ASSOCIATION (OBCA)

Ormoc, City, Leyte

BASKETBALL SHOOTOUT COMPETITION 2020

October 2020

REGISTRATION FORM

NAME:
Family Name First MI
CATEGORY (Please check one)

ELEMENTARY ( ) JUNIOR HS ( ) SENIOR HS ( ) COLLEGE /OPEN ( ) GIRLS ( )

CURRENT ADDRESS: _____________________________________________

CONTACT NUMBER: ______________________________________________

DATE OF BIRTH AGE PLACE OF BIRTH

HEIGHT WEIGHT NATIONALITY

GRADE/YEAR LEVEL: __________

LEARNERS REFERENCE NUMBER (LRN): __________________

SCHOOL: __________

COURSE (IF COLLEGE): __________STUDENT/ ID NO.: ___________

In case of emergency, please call

NAME: _________________________________ CONTACT NO: _______________________

ADDRESS: _________________________________________________________________

This Registration form, with registration fee of Php 100.00, must be submitted at The Generics Pharmacy
(TGP) Real St., in front of CHINABANK ORMOC on or before September 30, 2020.
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WAIVER and OATH
I authorize that in consideration for accepting my registration and permitting my voluntary participation in
the BASKETBALL SHOOTOUT COMPETITION 2020, I hereby release, discharge, and hold harmless
the Ormoc Basketball Coaches Association and LGU-Ormoc and all of their volunteers and other
representatives from any claims arising out of or relating to any damage or physical injury that I may suffer
while participating in the said competition.

Furthermore, I oath to practice the minimum health protocol like observing social distancing, washing
hands with alcohol, wearing face mask and face shield with QP and QR with only 1 companion to watch.
I will leave the venue after my turn to shoot.

I have read and fully understand the above statement.

NAME & SIGNATURE OF PLAYER DATE