Republic of the Philippines

Department of Education
Region VI—Schools Division of Capiz
PONTEVEDRA NATIONAL HIGH SCHOOL
Smashing Dragons Badminton Club
Tacas, Pontevedra 5802, Province of Capiz
School Telephone Number: (036) 6213-642

MEMBERSHIP FORM
I. Personal Information

Name: __________________________________________________________________________
Address: _________________________ Contact Number: __________________________
Date of Birth (M/D/Y): _____________________ Gender: ___________________________
Height: _____________________________________ Weight: ____________________________

II. Athletic Experience/Background

Participation in Competition
Level Name of Competition Date Venue Award/Place
(Local, Regional, National)

III. Parent’s Consent

I, _____________________________, parent of ________________________ give my full

consent and permission to my son/daughter _________________________________ to
join the above-mentioned sports club.

I am fully aware that the club will provide training and various opportunities
including participation in different kinds of competition to my child. I hereby
acknowledge that the school, the club, the school heads, and the teachers will not
be held responsible for any untoward incident that may happened to my child. I
also declare that my child is physically and medically fit to participate in this club
and its activities.

____________________________
Signature Over Printed Name of Parent
____________________________
Relation to the Child
____________________________
Date Signed
____________________________
Contact Number
Certified True and Correct: Accepted as Member: Accepted as Member:
_____________________ _____________________ _____________________
Signature of the Student Over Printed Name Signature of the Adviser Over Printed Name Signature of the Adviser Over Printed Name

Date Signed:_______________ Date Signed: _______________ Date Signed: _______________

Grade & Section: _____________

Noted:
_________________________
Signature of the Sports Coordinator Over Printed Name

Date Signed: _______________

Bringing opportunities to greater heights . . .