Republic of the Philippines

OFFICE OF THE CITY MAYOR

City of Davao
SPORTS DEVELOPMENT DIVISION

2014 BATANG PINOY MINDANAO QUALIFYING LEG

FULL NAME OF PARTICIPANT:___________________________________________________________
Date of Birth Age:_____________________________________________________________________
Address: ___________________________________________________________________________
School: _____________________________________________________________________________
Name of Parent/Guardian: ______________________________________________________________
Contact No.: _________________________________________________________________________
SPORTS EVENT: _______________________________________________________________________

PARENTAL CONSENT
As parent / legal guardian of the participant, I hereby give my full consent and approval for my
son/daughter/ward to join the Davao City delegation, competing in the 2014 Batang Pinoy Mindanao
Qualifying Leg on September 10 to 14 in Pagadian City, Zamboanga del Sur. I understand that there
are certain risks of injury inherent in this activity and other related activities incidental to the
participation, and I am willing to assume these risks. In addition to giving my full consent for my
childs/ wards participation, I do hereby waive, release the Sports Development Division and its staff
from any liabilities whether criminal or civil for any injuries that may be incurred by my child/ ward in
the normal course of the said tournament and the activities incidental thereto.
______________________________________
Parent/Guardians Signature over Printed Name
======================================================
MEDICAL CERTIFICATE
To Whom It May Concern:
This is to certify that ________________________ has been thoroughly examined by me and that
he/she is not suffering from weak heart, defective lungs, or some communicable disease that will
endanger his/her health or the health of other people. He/She is therefore physically and mentally fit
to participate 29th Kadayawan sa Davao Sports Festival on _________________.
__________________________

(Signature over printed name of physician)

License No: ___________________________
Date: ________________________________