2020 SMART/MVP SPORTS FOUNDATION ONLINE NATIONAL PTA-

MILO TAEKWONDO POOMSAE CHAMPIONSHIPS

ENTRY FORM AND WAIVER
FULL NAME: MAMUTUK, AQEEL NIKOLAI ARUMPAC
REGION: Region 10B CHAPTER: PRECKA TAEKWONDO ILIGAN
GENDER: Male DIVISION: Toddler Male
NCC NUMBER: For renewal BELT BROWN
YEAR OF BIRTH: April 6, 2016 INSTRUCTOR: JUNE RHEY M. BABATIDO
CERTIFICATION AND WAIVER
1. I hereby certify that the above information is true and correct.
2. I do hereby waive and release any and all rights and claims for damages against the organizing officials, their respective agents,
or any facility of this selection from any and all injuries which may be sustained during this activity.

APPLICANT'S SIGNATURE PARENT'S / GUARDIAN'S NAME & SIGNATURE (FOR MINORS)