CSAA ‘19 Theme: Through Sports: Yes, YOUth can!

CATHOLIC SCHOOLS ATHLETIC ASSOCIATION (CSAA) MEET 2019

ATHLETE’S RECORD
(To be filled by the athlete in his/her own handwriting)

Name: ___PIATOR, _______ ______________________________

(Last Name) (First Name) (Middle Name)
Date of Birth: __ _____ Age: ________ Place of Birth: _
(Per Birth Certificate)
House Address: __
School: ___ .________
Name of Parents: _______________________ _______ __
(Father) (Mother)
Address of Parents: _ ____
Cellphone Number: ___________________________

_______________________________
(Signature of Athlete)
______________________________
Sports Moderator/ Coach

MEDICAL CERTIFICATE

Date: __________________

TO WHOM IT MAY CONCERN:

This is to certify that __________________________________ has been thoroughly

examined by me and that he/she is not suffering from weak heart, defective lungs, or some
communicable disease that will endanger his/her health or the health of the other people.

He/she is therefore physically and mentally fit to participate in the __________________.

__________________________________
(Signature over printed name of physician)
License No. : _______________________
Date : _____________________________

PARENT/ GUARDIAN CONSENT

Date: ______________________

TO WHOM IT MAY CONCERN:

This is to expressly allow my son/daughter ____ __________ to participate in

the CSAA MEET 2019 for the school year 2019-2020.

Aware that such athletic activities will exercise utmost care and precaution during the
activities, I shall not hold the management conducting CSAA MEET 2019 liable of any
untoward incident that may happen that is beyond their control. I am giving my consent
willingly.
________________________________________
(Signature of Parents/Guardian over printed name)
 CSAA MEET 2019
ENTRY FORM
Event : __________________________________ Level : _________________________

Name of Team : ________________________________________________________________

Jersey No. : ______________

Name : ______________________________________________

(2x2 Picture) Address : ____________________________________________

___________________________________________________

Age : _____________ Date of Birth : _____________________

Jersey No. : ______________

Name : ______________________________________________

(2x2 Picture) Address : ____________________________________________

___________________________________________________

Age : _____________ Date of Birth : _____________________

Jersey No. : ______________

Name : ______________________________________________

(2x2 Picture) Address : ____________________________________________

___________________________________________________

Age : _____________ Date of Birth : _____________________

Prepared by: Noted by:

___________________________________ ___________________________________
Sports Coordinator/Director OSA Director