Colegio San Agustin Makati

Palm Ave., Dasmariñas Village, Makati City

P.O. Box 21351CPO/Code1261
Tels. 8443723 – 26 * 8442002 – 03 * 8442005
Website: www.csa.edu.ph
E-mail address: info@csa.edu.ph

SPORTS DEPARTMENT SY 2023-2024

Varsity Participation Parental Consent Form

Please print and use BLUE or BLACK ink only.

Name: _________________________________________________________________________________________________________________
(SURNAME) (FIRST NAME) (MIDDLE NAME)

Grade and Section: ____________________ Email Address: __________________________________________________

Date of Birth (MM/DD/YYYY): __________________________________ Age: ___________________________

Address: ______________________________________________________________________________________________________________

Contact Number: _________________________________________________

Known Medical Condition/s: ________________________________________________________________________________________

Known Allergies: _____________________________________________________________________________________________________

Medications: __________________________________________________________________________________________________________

Name of Father: ______________________________________________________________________________________________________

Name of Mother: _____________________________________________________________________________________________________

Telephone: Home: _________________________ Work: _________________________ Mobile: ________________________

Please give an emergency contact (must be 21 or older) and method to contact if parents cannot be
reached:

Name: ____________________________________________________ Relationship: ___________________________________________

Phone Number: _________________________________________ Alternative Number: __________________________________

WARNING!!! Although tryouts and/or participation in a supervised Varsity program and its activities
such as tryouts, training sessions, and official games may be one of the least hazardous in which students
will engage in or out of school, BY ITS NATURE, PARTICIPATION IN A VARSITY PROGRAM INCLUDES A
RISK OF INJURY WHICH MAY RANGE IN SEVERITY FROM MINOR TO LONG – TERM CATASTROPHIC,
INCLUDING PERMANENT PARALYSIS FROM THE NECK DOWN OR DEATH.

Student-athletes can and have the responsibility to help reduce the chances of injuries.
STUDENT-ATHLETES MUST OBEY ALL SAFETY RULES, REPORT ALL PHYSICAL PROBLEMS TO THEIR
COACHES, AND FOLLOW A PROPER CONDITIONING PROGRAM.

By signing this permission form, you acknowledge that you have read and that you understand this
warning. PARENTS/GUARDIANS OR STUDENT-ATHLETES WHO DO NOT WISH TO ACCEPT THE
RISKS DESCRIBED IN THIS WARNING SHOULD NOT SIGN THIS PERMISSION FORM.

I (We) hereby give consent for ___________________________________________________________________________________ to

join the _____________________________________________________ Varsity Team of Colegio San Agustin Makati for
school year __________________________.

1) ________ I have read and understood the contents of the “Guide for CSA Student-Athletes”.
2) I hereby verify that the information on this form is correct and understand that any false
information may result in my son/daughter being declared ineligible to be part of the Varsity
Program.
3) Parents/Guardians should contact the Head Coach for information regarding injuries to their
son/daughter.

This acknowledgement of risk and consent to allow participation in the CSA Varsity Program
for the school year ____________________ shall remain in effect until revoked in writing.

_____________________________________________________________________ ____________________________________________
Signature Over Printed Name of Student-Athlete Date

_____________________________________________________________________ ____________________________________________
Signature Over Printed Name of Father Date

_____________________________________________________________________ ____________________________________________
Signature Over Printed Name of Mother Date