1ST MRS BARES MAYOR’S CUP BASKETBALL TOURNAMENT

PLAYER’S PERSONAL INFORMATION

Name: PORLANTE NEPTALIE _ BALLOCANAG

Surname Name Middle Name
Date of Birth: _____________________ Contact Number: _________________________

Place of Birth: _____________________ AGE: ______ old Height: ______Weight: ______

Address: ________________________________________________________________________

Person to notify in case of emergency: ________________________________________________

Address and Contact Number: _______________________________________________________

Are you physically fit to attend this tournament? [ ] yes [ ]no

CERTIFICATION
I do hereby certify that all facts and information indicated herein are true and correct to the
best of my knowledge and belief. I certify that I am physically fit to participate in this tournament. I do
hereby waive and release all my rights for the damage/accident that may rise against the management
of this tournament.

______________________________________
Signature over Printed Name of Player

Attested by:

SALGIE P. SERNAL
Signature over Printed name
Parent/Guardian/Coach