MEDICAL CERTIFICATE

PALAMIDIO CHAMPIONSHIP

APPLICATION FORM ATHLETES

Palamideio Championship

Closed Nafplion Fitness

Responsible racing entry form

The undersigned hereby declare that I am an athlete with Bulletin No. "....................................... .. ............ .." I am absolutely healthy and have undergone in the last semester statutory relevant medical examination by a doctor, which shows that I can play without risk my health. Also hereby declare that he is free from communicable diseases that can harm the health of people around me with my responsibility and my own negligence. Take part in races on a recognition that the nature of the sport, martial art, which scramble (.......................................) used normally blows full contact or imiepafis body and face and on this speech can cause injuries and accidents. For that reason exempt from any liability to the Land of the sport, the board members of the Association, the address of the gym, coaches, doctors covering the race organizers and referees for matches in which will take part as well as the My teammate and coaches with whom I fight. Surrender is the right turn judicial or extrajudicial, me or my relatives against those for the above reasons, as well as the claim of unjust enrichment. This form is signed by the physician of the match that made the current medical examination and has no comments or reservations for the participation of the athlete in the games. Sports Items NAME ............................................................... .. NAME ...................................................................... ADDRESS ............................................................... AREA .................................................................. .. CITY / Zip. .................................................................. DATE / DATE OF BIRTH ................................................. TELEPHONE ................................................................ NUM. Delta. ID. ................................................. SIGNATURE ATHLETE DATE / DATE EVENT VENUE ________________________ PHYSICIAN MATCH If the athlete has not attained 18 years of age. guardian Details NAME ............................................................... .. NAME ...................................................................... NUM. Delta. ID. ................................................. GUARDIAN SIGNATURE