Form 3

STRASUC BUBBLE COMPETITION

Southern Luzon State University, Lucban
Quezon

Theme:

ELIGIBILITY FORM

PARTICIPANTS PERSONAL INFORMATION

NAME OF ATHLETE: Ivvane Charles C. Almonte AGE: 22

DATE OF BIRTH: May 20, 2000 WEIGHT: 76kgs HEIGHT:

BLOOD TYPE: Type O ALLERGIES: N/A Medications (if any): N/A
ADDRESS: Greenfields Subd. Brgy, Sampaloc Pagsanjan, Laguna CONTACT #: 09555294067
YEAR & COURSE: BSBA-HRM 4B
EVENTS: Basketball
==================================================================================

MEDICAL CERTIFICATE ATHLETES WAIVER AND RELEASE AGREEMENT

This is to certify that: In consideration of the acceptance of my entry, myself,

my heirs, executors, administrators and assigns, do
hereby release and discharge the organizers of the
is Physically Fit to participate in the following competitions; FACE- TO- FACE BUBBLE COMPETITION, assisting
groups of private or government agencies, the
Commission of Higher Education, and other concerned
[ ] : Regional Bubble Competition on institutions, respective schools and officials, and other
(date) at parties, individual or group, from all claims and
April 23-29, 2022 damages, demands or actions whatsoever in any
B manner arising from or growing out of my participation
Southern Luzon, State University, in, or while traveling to and from the above-mentioned
Lucban Quezon sports competition. I further attest and verify that I
have obtained the necessary clearance from my
medical doctor and guaranteed Physically Fit to
Blood Pressure:
participate in the said sports competition.

Name and Signature of 09555294067

Physician
IVVANE CHARLES C. ALMONTE
Date of Examination: Name and Signature of Contact Number
Athlete
License Number Validity Date

PARENT/GUARDIAN PERMIT/CONSENT

This is to certify that I have full knowledge of and permission for my son/daughter/foster child to join and participate in
the following competition;

[ ] STRASUC BUBBLE April 23-29, 2022 at Southern Luzon State University,

COMPETITION on Lucban Quezon

I concur and agree on the rules, policies and regulations being implemented by the concerned organizers.

VICTORIA ALMONTE 09293905822

Name and Signature of Parent/Guardian Contact Number

========================================================================