I am the servant of the Lord, may it be done to me

according to your word. [Lk 1:38]

PARISH YOUTH DAY 2019

Diocese of Calbayog – Commission on Youth
2019 Oct 30- Nov 1 | Immaculate Conception Parish

PLEASE READ: As an PYD2019 pilgrim, you are asked to accomplish this IRF

IRF
completely, providing truthful information. Read the form fully and carefully
before answering, particularly Part D: “Authorization and Waiver”.

When ready, write neatly and legibly, using BLOCK letters. Submit your
accomplished IRF to your Delegation Head, who should submit to the PYD2019
Organizers all the IRFs in your delegation not later than October 19, 2019. INDIVIDUAL REGISTRATION FORM

A. ORIGIN

Parish/ Organization /Local Unit City or Municipality / Barangay

B. PERSONAL DETAILS
MR. MS.
FR. BR. SR.

Title Last Name FirstName M.I. Nickname

Birth Year Birth Month Birthday Age Mobile Phone Number Working Email Address

Current Occupation Shirt Size Role in Ministry

Home Address
 C. CONTACT PERSON (IN CASE OF EMERGENCY)

Full Name Relation to You Contact Number

D. AUTHORIZATION AND WAIVER

Each PYD2019Motiong delegate must personally sign this Authorization and Waiver. If the delegate is a
minor (i.e. between 13-17 years of age by the date of travel to the PYD2019Motiong), then this must be
signed by either of his/her parents or by his/her legal guardian.

I, _______________________________________, a citizen of the REPUBLIC OF THE PHILIPPINES, of legal

age, a resident of ___________________________________________________________, do hereby
depose and state that:

I freely and voluntarily applied as a participant to the PARISH YOUTH DAY 2019 (PYD2019) to be held
on Oct 30 –Nov 1 2019 in the Immaculate Conception Parish, Motiong City;
I promise to faithfully adhere to all the guidelines and comply with all requirements, as well as to
those to be given by the Organizers;
I confirm that all information herein is correct and accurate to the best of my knowledge, and I
authorize the PYD2019Motiong Organizers to use with discretion the information contained herein as
they deem necessary and legitimate;
As a participant, I commit to attend all the PYD2019Motiong events, from its commencement until
conclusion;
I shall exercise extraordinary diligence, as that of a good father to his family, to prevent injury to
myself and to my fellow participants and to the Organizers and volunteers;

I hereby waive, release and discharge the PYD2019Calbayog Organizers from any and all liabilities
that can occur as a result of my actions during this event.

I affix my signature below to certify that I have read this waiver and that I fully understand its content.

Full Name Signature Date