BAGUIO CENTRAL UNIVERSITY

ATHLETIC DEPARTMENT
VARSITY FORM

Date: November 28, 2022

______________________________________________
(Karate, Arnis, Taekwondo)
SPORTS DISCIPLINE

Student ID Number: ____________

___New ___Old Sex: ____________

A. PERSONAL DATA:

Name: _______________________________________________________________________________
(Surname) (First Name) (M.I)
School Last Attended: ___________________________________________________________________

Course: _______ (1st Course: _____ 2nd Course: _____ Shift to other Course: ______) Curr. Year: _____

City Address: __________________________________________________________________________

Birth Date: _______________________ Place of Birth: ________________________________________

Father’s Name: ___________________________________ Occupation: __________________________

Mother’s Name: __________________________________ Occupation: __________________________

EDUCATIONAL BACKGROUND

Name of School Address of School Year Graduated

Primary: _______________________________ ___________________________________ ______

Intermediate: ___________________________ __________________________________ ______

SHS: ___________________________________ ___________________________________ ______

Others School, University (if transferee):

_______________________________ ____________________________________ ______

Number of units last semester attended: _____ Number of units in progress: _____

Number of playing years (BBEAL): _________

I hereby agree to abide by the existing rules and regulations of Baguio Central University Varsity Team
and those that maybe adopted from time to time by the Athletic Department. (Smoking and liquor are
prohibited/ No Practice No Scholarship)

______________________
Signature

_____________________
Contact Number

________________________________________
Parent’s Signature over Printed Name

_______________________________
Tel. Number (Home/Parents)
B. ATHLETE’S PARTICIPATION IN LOCAL/INTERNATIONAL COMPETITION
Accomplish the following properly.

NAME OF COMPETITION PLACE OF COMPETITION LOCAL/REGIONAL/ DATE RANK/PLACE

NATIONAL/
INTERNATIONAL

I hereby certify that all information that I have provided in this form are true to the of my
knowledge.

_________________________________ ___________________
Signature over Printed Name Date