2018 REGIONAL SCHOOLS PRESS CONFERENCE CLINIQUING

Liliw National High School

Liliw, Laguna
Oct. 24 - 27, 2018

PARTICIPANT’S INFORMATION SHEET

Name RABE BIANCA YSABEL D.

Last Name Given Name M.I.
School PHILIPPINE HIGH SCHOOL FOR THE ARTS

Name of
School Paper VARIATIONS
Name of
School Paper
Adviser JON DARREN V. RIVERA
Category FEATURE WRITING SECONDARY Eng X Fil ____
Contact No. 0977 816 3872 Birthday: 16 April 2002 Age: 16 Gender: F

Grade and Section : GRADE 10 – CUENTOS

WAIVER

This is to permit my/our child, BIANCA YSABEL D. RABE, to join the 2018 Regional Schools Press Conference Cliniquing on
September 25-27,2018 at Liliw National High School, Liliw, Laguna.
I expressly waive any and all claims against the school, the organizers, and or its representative on the account of any
incident/injury or damage to personal property that may occur beyond the control of the delegation head provided that adequate safety
measures and precautions have been instituted in connection with the participation of my/our child in the above-mentioned activity.
I/We further agree that the said student-journalist participant will undergo health examination required.

ROENTGEN R. RABE AIMEE RACHEL D. RABE

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

MEDICAL CERTIFICATION

This is to certify that BIANCA YSABEL D. RABE of VARIATIONS, PHILIPPINE HIGH SCHOOL FOR THE ARTS (School) appeared
before me, and found him/her PHYSICALLY FIT to join the above-mentioned activity.

Health history of _____________________________________________________________________________________________________

Have or subject to (check if yes) Have or subject to trouble with: Have had:
fainting spell eye, ear, nose, throat allergy
shortness of breath recurrent diarrhea lungs
easy fatigue diabetes malaria
chest/abdominal pain hypertension measles
palpitation/convulsions hernia mumps
headache, frequent fever & cough heart chicken pox
others kidney whooping cough

Height: _______ Systolic/Diastolic: __________ OTHER FINDINGS/MEDICATIONS:

Weight: _______ Body Temperature: ________

_______________________________MD.
License No.:______________________

SCHOOL’S CERTIFICATION

This is to certify that BIANCA YSABEL D. RABE is a bonafide student of the PHILIPPINE HIGH SCHOOL FOR
THE ARTS and belongs to GRADE 10 - CUENTOS for School Year 2018-2019. He/She is a member of VARIATIONS
and serves as the FEATURES EDITOR.

__MR._JON DARREN V. RIVERA_________ _VICTOR EMMANUEL CARMELO D. NADERA, JR., PHD._

Signature of Adviser over Printed Name Signature of Principal over Printed Name