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SDO Off Campus

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11 views4 pages

SDO Off Campus

Uploaded by

Fake Account
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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MEDICAL CERTIFICATE

Name of the Athlete: ____________________________________________________________


Surname First Middle

Event: ___________________________

Date of Birth: _____________________ Place of Birth: ______________________


Height (in meters) :_________________ Weight (in kg): ____________________
Heart Rate (at rest): ________________ Blood Pressure (at rest): _____________

Physical Signs Disorder of:


YES NO YES NO
 Heart ()()
 Vascular System ()()
 Lungs ()()
 Liver ()()
 Spleen ()()
 Mammary Glands ()()
 Endocrine Organs ()()
 Locomotor Organs ()()
 Lymph Glands ()()
 Genital Organs ()()

If yes, give details under Remarks.

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
__________________________________________

Do you consider the athlete at present for his/her participation in _________________?

YES ( ) NO ( )

Name of Examining Physician: ____________________________________


Signature: _________________________ Date: ______________________

BulSU – OP – SDO – 02F3


Revision: 1
Coaches / Asst. Coaches / Trainer Companion Form

This serves as a notification for the Coaches / Asst. Coaches / Trainers companion of the student
athletes for the following indicates activity. The Coaches / Asst. Coaches / Trainers companion will act as
guardian of the participants of the activity.
Please affix a photocopy of the BulSU identification card of the Coaches / Asst. Coaches / Trainer
companion.

Name of Sport Event:____________________________________________________

Name of Activity:________________________________________________________

Venue of Activity: _______________________________________________________

Name of Team Captain Ball: ______________________________________________

Contact No. of Team Captain Ball: __________________________________________

Name of Coach: _______________________________________________________

Faculty Position: Regular Part –Timer

Contact Number/s _______________________________________________________

Email Address: _________________________________________________________

_______________________ __________________________
(Signature over printed name) (Signature over printed name)

Team Captain Ball Coach / Asst. Coach / Trainer Companion, Sports Development

I hereby manifest my understanding that I ought to be present during the whole duration of
the activity. I also understand that I have to oversee the member of the organization and the
specified activity and to ensure that the guidelines and rules set by Bulacan State University are
observed.

I am signing this form as a notification of my accountability for the organization.

__________________________________________
(Signature over printed name)
Coach /Asst. Coach / Trainer Companion, Sports Development

BulSU – OP – SDO – 02F2


Revision: 1
PARENTAL CONSENT FORM

Name of Student / Athlete: _____________________ Student Number:_________________

Course: ____________________________________ Year and Section: ________________

Name of Sport: ______________________________________________________________

Nature of Sport: Training


Competition
Seminar / Workshop
Others: _____________________________

Venue: _________________________ Inclusive Dates: ____________________

To be filled – up by the Parent / Guardian:

I allow my son / daughter to attend the activity.


I trust that the organizer of this activity will take due diligence to ensure the safety of my
son / daughter as a participant. I also agree to absolve the university from legal
responsibility on any untoward incident in the course of the event.

I do not allow my son / daughter to attend the activity.

Name of Parent / Guardian: _______________________________________________

Phone / Cell phone number(s): ____________________________________________

Address: ______________________________________________________________

Specimen Signatures: _______________ ________________ _______________

Note:
Please affix a photocopy of the Parent’s / Guardian’s identification card with signature.

BulSU – OP – SDO – 02F1


Revision: 1
LIST OF PARTICIPANTS FORM

Event: _________________

Date: __________________

Name of Athletes Student No. Contact Number

1. ______________________ _________________ ________________

2. ______________________ _________________ ________________

3. ______________________ _________________ ________________

4. ______________________ _________________ ________________

5. ______________________ _________________ ________________

6. ______________________ _________________ ________________

7. ______________________ _________________ ________________

8. ______________________ _________________ ________________

9. ______________________ _________________ ________________

10. ______________________ _________________ ________________

11. ______________________ _________________ ________________

12. ______________________ _________________ ________________

13. ______________________ _________________ ________________

14. ______________________ _________________ ________________

15. ______________________ _________________ ________________

16. ______________________ _________________ ________________

17. ______________________ _________________ ________________

18. ______________________ _________________ ________________

BulSU – OP – SDO – 02F4


Revision: 1

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