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Department of Education

Region I
Division of La Union
Bauang North District
REGIONAL SCHOOLS PRESS CONFERENCE 2019
REGESTRATION FORM

Name: Janel Claire N. Taala Gr./ Yr. Level: Grade 6


Contact Number: 09369456950
Name of School: Baccuit Elementary School District: Bauang North District
Division: La Union
Contest Category: ________ Elementary ________ High School
Medium Used: ________ English ________ Filipino ________ Mother Tongue
Name of School Paper: ________________________
Name of Adviser / Coach: Mark Anthony O. Fontanos
Name of School Principal: Winda G. Mazon
__________________________________________________________________________________________________
MEDICAL CERTIFICATE
To whom it may concern:

This is to certify that ________Janel Claire N. Taala________________ has undergone a medical


examination and was found out to be physically and mentally fit to participate in the regional
School Press Conference to be held at Pan-Pacific University of Northern Philippines, Tayug,
Pangasinan on November 7-8, 2019.
Thank you and God Bless!

_________________________________ Lic. No. ____________________


Physician/Medical Officer
(Signature over printed name)
__________________________________________________________________________________________________
PARENTAL CONSENT
This is to certify that we are allowing our son/ Daughter ____Janel Claire N. Taala____ to
attend and participate in the 2019 Regional Schools Press Conference to be held in Pan-Pacific
University of Northern Philippines, Tayug, Pangasinan on November 7-8, 2019.
Furthermore, we are fully aware that in case our child wins in the said contest. He/she is
required to join the National Schools Press Conference to be held in
_____________________________________________.
____________________________________________
Signature over Printed Name of Parent/s or Guardian

____________________________________________ ___________________________
Home Address Contact Number
__________________________________________________________________________________________
CERTIFICATE OF ENROLMENT

To whom it may concern


This is to certify that ____Janel Claire N. Taala____ is currently enrolled at BACCUIT
ELEMENTARY SCHOOL for the school year 2019 – 2020.
Issued this ____ day of November, 2019 at Baccuit Sur, Bauang, La Union for all legal intents
and purposes it may serve.

_________________________________
Signature over Printed Name of Principal

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