2/21/22, 9:31 PM

2022 Virtual Academy for Excellence of

Calapan City
REGISTRATION FORM

Name:_______________________________________________________________________
ZYRUS KENTER BONADOR CAIBAL
First Name Middle Name Family Name

Age:______Gender:__________Date
11 Male of Birth:_______________
06/20/11

School: ____________________ Grade/Year Level: Grade

ADRIATICO MEMORIAL SCHOOL ______4 Contact Number:_____________
09392299722

Event to be enrolled:
HAND DRAWING(Beginner 8-15 Years Old)

ATHLETE’S DECLARATION OF FITNESS AND WAIVER

I, ____________________________________________,
ZYRUS KENTER BONADOR CAIBAL with postal and residence address at
_______________________________________________________________________,
TIBAG,CALAPAN CITY hereby
confirm and declare that:

1.I am participating in the Virtual Workshop & Sports Clinic to be held on _____________ at Calapan
City, of my own free will, desire, and volition.

2.I hereby represent and warrant that I am physically fit to participate and take part in the CITY
VAX: Virtual Academy for Excellence of Calapan City and have none known illness, physical defect, or
adverse medical condition that would render me unfit. Should subsequently discover any illness,
physical defect, or adverse medical condition that would render me unfit to participate in the CITY
VAX: Virtual Academy for Excellence of Calapan City, I shall advice the Organizer in writing and I
shall accordingly refrain from participating in any event of the CITY VAX.

3.I hereby authorize the Event Organizer to use my name, photographs, videos and interviews in
connection with the CITY VAX: Virtual Academy for Excellence of Calapan City in broadcast and print
media, videotapes, etc. without any monetary consideration.

4.I agree to abide by the decision of the Organizer on any issue relative to my participation in the
CITY VAX: Virtual Academy for Excellence of Calapan City, including but not limited to official calls
and the interpretation of rules governing the Activity, and shall accept as final any decision of the
Organizer regarding any dispute over such rules or regarding the manner of holding the Activity.

5.I shall hold the Organizer, the City Government of Calapan, free and harmless from any and all
claims arising from any accident, damage, illness, death, or loss that I may suffer as a result of my
participation in the CITY VAX: Virtual Academy for Excellence of Calapan City.

I hereby declare that I have read and understood this Declaration of Fitness and Waiver and that I
have executed this document willingly and voluntarily.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of __________, ________ at

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 2/21/22, 9:31 PM

________________________________.

_________________________________________
ZYRUS KENTER BONADOR CAIBAL
(Printed Name and Signature) Participant

PARENT’S WAIVER

I, ______________________________________
FLORDELIZA B. CAIBAL hereby represent that I am parent/guardian of
______________________________________
ZYRUS KENTER BONADOR CAIBAL and I have given my consent for him/her to join and
participate in the CITY VAX: Virtual Academy for Excellence of Calapan City. I hereby certify that my said
child/ward is physically, mentally and psychologically fit to participate in the said CITY VAX: Virtual
Academy for Excellence of Calapan City. In case he/she will qualify, I will allow my child/ward to
participate in the CITY VAX: Virtual Academy for Excellence of Calapan City which will be on
____________ at Calapan City. I hereby discharge the committee (organizers, officials and assigned
staff) of the CITY VAX: Virtual Academy for Excellence of Calapan City from all claims of damages and
demands as a result of participation of my child to this event.

______________________________________
FLORDELIZA B. CAIBAL
(Printed Name and Signature) Guardian

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