ASSOCIATION OF PICE PANGASINAN STUDENT CHAPTER

1ST APPSC CE GAMES

PLAYER’S REGISTRATION FORM

SCHOOL: PHINMA University of Pangasinan

PERSONAL DATA
LAST NAME FIRST NAME MIDDLE INITIAL NICKNAME
CERDAN JOHN WARRY P.

ADDRESS CONTACT NUMBER

MANCUP,CALASIAO ,PANGASINAN 09123011343

AGE DATE OF BIRTH EVENT/SPORTS

20 FEBRUARY 23,1999 BASKETBALL

YEAR AND SECTION COURSE

5th Year BSCE

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PARENTAL CONSENT

TO WHOM IT MAY CONCERN,

I, Mr./Mrs.Sotero C. Cerdan,Parent/Guardian of John Warry P. Cerdan .Give full

permission to him/ her to join the 1 ST APPSC CE GAMES on January 24 & 25, 2019 (8:00AM-
5:00PM) . I acknowledge and accept that my son’s/daughter’s participation in the said event is
entirely voluntary, and all risk is voluntary assumed by my son/daughter and me. I also fully
understand that the rules and regulations of the Department of Association of PICE Pangasinan
Student Chapter will be in effect. I must also ensure that he/she understand that it is needed for
his/her safety and for the safety of the team he has, that all rules and instructions given by the
group leaders are obeyed.

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Signature over printed name of Participant

______________________________________
Signature over printed name of Parent/Guardian
Contact Number: _____________________