Bicol University

University Sports Development Program Office

Legazpi City

BICOL UNIVERSITY INTRAMURALS/SELECTION/OLYMPICS

PARENT’S CONSENT/WAIVER

Date

To whom it may concern:

This is to certify that I/We, the undersigned parent/guardian, do hereby give my full consent and
John Michael Rustria
approval for my son/daughter ____________________________________________to participate in the
(Name of Player)
Chess
__________________________________________ Bicol University Sports Complex
to be held at ________________________________
(Event) (Venue)
October 26 - 27
on __________________________.
(Date)

Considering the benefits that will be derived from participation in such activity for the interest of
our child/ward, we voluntarily release any claim against the school/coach/trainer and authorities in
charge, for any untoward incidents that may occur, God forbids, beyond control in the course of his/her
participation after all precautionary measures and exhausting effort have been taken by the person in
charge.

th
11
Done in _______________________________ this ________ October 20___.
day of _____________, 22

Edgardo B. Rustria
Parent/Guardian Signature Over
Printed Name

MEDICAL CERTIFICATE

To whom it may concern:

This is to certify that ____________________________________________has submitted

(Name of Player)

himself/herself for physical examination this _______ day of _________________, 20___ and is certified

to be physically fit to join and compete in the event stated above.

_______________________
Attending Physician