Surat Pernyataan Khusus Kehamilan
Saya, yang bertandatangan dibawah ini:
Nama : _______________________________________________________________
KTP / ID : _______________________________________________________________
Tempat &
Tanggal Lahir : _______________________________________________________________
No. Telepon : _______________________________________________________________
Email : _______________________________________________________________
Menyatakan bahwa saya telah memperoleh surat izin/rekomendasi dari dokter ahli mengenai kondisi kehamilan saya dan partisipasi saya di OPPO Run 2025 Powered by myBCA. Saya sadar dan menerima bahwa partisipasi saya di OPPO Run 2025 Powered by myBCA memiliki resiko kesehatan terutama dalam masa kehamilan saya. Saya telah membaca syarat dan ketentuan dari OPPO Run 2025 Powered by myBCA dan membebaskan penyelenggara serta seluruh pihak terkait dari segala tuntutan yang dapat terjadi dari kepartisipasian saya di OPPO Run 2025 Powered by myBCA.
______________________, _________________________ 2025
_______________________________________
(TTD dan nama Jelas)
Pregnancy Statement Letter
To whom it may concern,
I, whose name is signed under this letter,
Name : ___________________________________________________________
ID Number : ___________________________________________________________
Place, Date of birth : ___________________________________________________________
Phone Number : ___________________________________________________________
Email : ___________________________________________________________
With this I declared that I have obtained a letter of permission/recommendation from a specialist doctor regarding my pregnancy condition and my participation in OPPO Run 2025 Powered by myBCA. I am aware and accept that my participation in OPPO Run 2025 Powered by myBCA has health risks especially during my pregnancy. I have read the terms and conditions of OPPO Run 2025 Powered by myBCA and released the organizer and all related parties from any claims that may arise from my participation in OPPO Run 2025 Powered by myBCA.
______________________, _________________________ 2025
_______________________________________
(Participant’s name & signature)