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    RSPC Med Cert

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    Charietism Park
    1. This document contains an application form for journalists to participate in the Regional Schools Press Conference to be held in Tandag City, Philippines in November 2019. 2. It requests information such as the applicant's name, address, birthdate, height, weight, school, journalism event and category. 3. The form also includes a parental consent section for permission for their child to participate and a waiver of liability, which requires signatures of the mother, father or guardian.

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    RSPC Med Cert

    Uploaded by

    Charietism Park
    25 views1 page
    1. This document contains an application form for journalists to participate in the Regional Schools Press Conference to be held in Tandag City, Philippines in November 2019. 2. It requests information such as the applicant's name, address, birthdate, height, weight, school, journalism event and category. 3. The form also includes a parental consent section for permission for their child to participate and a waiver of liability, which requires signatures of the mother, father or guardian.

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    Rspc Med Cert

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    1. This document contains an application form for journalists to participate in the Regional Schools Press Conference to be held in Tandag City, Philippines in November 2019. 2. It requests information such as the applicant's name, address, birthdate, height, weight, school, journalism event and category. 3. The form also includes a parental consent section for permission for their child to participate and a waiver of liability, which requires signatures of the mother, father or guardian.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    25 views1 page

    RSPC Med Cert

    Uploaded by

    Charietism Park
    1. This document contains an application form for journalists to participate in the Regional Schools Press Conference to be held in Tandag City, Philippines in November 2019. 2. It requests information such as the applicant's name, address, birthdate, height, weight, school, journalism event and category. 3. The form also includes a parental consent section for permission for their child to participate and a waiver of liability, which requires signatures of the mother, father or guardian.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Republic of the Philippines

    DEPARTMENT OF EDUCATION
    Caraga Administrative Region
    DIVISION OF SURIGAO CITY
    Surigao City

    JOURNALIST’S APPLICATION FORM


    Name: ___________________________________________ Nickname:__________________________________
    Home Address:____________________________________ Phone: ____________________________________
    Place & Date of Birth:_______________________________ Age: ______________________________________
    Weight:__________________________________________ Height: ____________________________________
    School:___________________________________________ Year: ______________________________________
    Event:__________________________________________________________________________________________
    (Journalism Genre) (Level-Elementary/Secondary) (Category-Filipino/English)

    _________________________________
    Signature of Journalist

    PARENTAL CONSENT AND WAIVER


    We here allow our son/daughter _______________________________________ to participate in the
    REGIONAL SCHOOLS PRESS CONFERENCE to be held at TANDAG CITY on November _____, 2019 and
    submit to the rules and regulations of the same. Furthermore, we hold the organizers, coaches, division journalism
    coordinators and this Division free from any liability in case of injury, illness, loss or damage of belongings,
    experienced in relation to and during the said activity by our child in the ordinary course of the undertaking.

    __________________________ __________________________ ____________________________


    Signature of Mother over Printed Name Signature of Father over Printed Name Signature of Guardian over Printed Name

    HEALTH EXAMINATION REPORT

    Respiratory System: _____________________________ Circulatory System: _________________________________


    Blood Pressure: ___________________ Systolic: ___________________ Diastolic: ____________________________
    Pulse Sitting:___________________________________ Agility Test After 3 mins.: ___________________________
    Digestive System:__________________________________________________________________________________
    Genito-Urinary: ____________________________________________________________________________________
    Urinalysis, etc.: ____________________________________________________________________________________
    Skin: _________________________________________ Loco motor System: ________________________________
    Nervous System: _______________________________ Eyes: Conjunctiva: Etc.: _____________________________
    Color Perception:___________________________________________________________________________________
    VISION: Without glasses-Far: __________________________ Near: ____________________________________________
    With glasses- Far: ____________________________ Near: _____________________________________
    Ear: _______________ Hearing: _______________ Right Ear: _______________ Left Ear: __________________
    Nose: _____________________ Throat: ______________________ Teeth &Gums: _____________________________
    Immunization & Date: _______________________________________________________________________________
    Temperature: ______________________________________________________________________________________
    Recommendation/s: _________________________________________________________________________________
    __________________________________________________________________.

    _________________________________
    Physician

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