REGISTRATION & WAIVER FORM Control No.

:
CATEGORY: FUN RIDE E DATE OF REGISTRATION: 01/12/2022
FULL NAME (LAST NAME, FIRST NAME, MIDDLE INITIAL): JESURA, KURT RYAN P.
HOME ADDRESS: PUROK MABUHAY, BRGY. PUNONG GRANDE, BANGA, SOUTH COTABATO
DATE OF BIRTH: AUGUST 23,1999 SEX: MALE AGE: 22 SHIRT SIZE: MEDIUM
MOBILE NUMBER & CONTACT DETAILS: 09630237166

IN CASE OF EMERGENCY:
NAME OF CONTACT PERSON: DONA P. JESURA CONTACT DETAILS: 09675968564

REQUIREMENTS:
1 1 PHOTOCOPY OF VACCINATION CARD OR Only fully vaccinated individual with vaccination cards or certification will
CERTIFICATION be allowed to join the challenge
2 1 PHOTOCOPY OF GOVERNMENT ISSUED VALID ID With Photo, Name, Address, and Birthdate
3 REGISTRATION & WAIVER FORM filled up and duly signed by the participant
4 REGISTRATION FEE Registration fee includes:
1 Full Sublimation event shirt
1 Meal Coupon
1 Finisher Certificate
1 Race Bib
*All requirements must be submitted upon registration. The organizer reserves the right to require any participant to present any proof that certifies his/her age
for us to be able to classify him/her to the appropriate category.

I, the undersigned, attest and certify that I am physically fit to join the bike competition dubbed as the 1 st Hinugyaw
Festival S.I.K.A.D. Challenge. Being aware of the risk involved, I and my heir/s do hereby assume the full responsibility of my
actions and forever waive my right to file legal and/or criminal charges against the event and its organizers.

I certify the information provided by me in this application form is true and correct, and that any false information made
herein will be enough ground for my disqualification.

I understand that it is my responsibility to know the race track/route and rules and regulations. Wrong tracks/route can
be used as ground for my disqualification.

I also understand that this is not the complete list of rules of the event and that the City Government of Koronadal
reserves the right to add, change, or modify the rules at any point in time.

Furthermore, I hereby undertake to abide by the rules and regulations of this race.

Signed this day of in Koronadal City, South Cotabato.

KURT RYAN P. JESURA

Signature over Printed Name of Participant

REGISTRATION RECEIPT
1ST HINUGYAW FESTIVAL SIKAD CHALLENGE
City of Koronadal Control No.:
January 16, 2021
CATEGORY: FUN RIDE E DATE OF REGISTRATION: 01/12/2022

FULL NAME (LAST NAME, FIRST NAME, MIDDLE INITIAL): JESURA, KURT RYAN P.
HOME ADDRESS: PUROK MABUHAY, BRGY. PUNONG GRANDE, BANGA, SOUTH COTABATO
DATE OF BIRTH: AUGUST 23,1999 SEX: MALE AGE: 22 SHIRT SIZE: MEDIUM
MOBILE NUMBER & CONTACT DETAILS: 09630237166