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    Sample Athletics Records Forms

    Uploaded by

    Halem Laroya Lucernas
    The document contains information about the Cebu Province Sepak Takraw Boys event, including: - The names, schools, and contact details of the coach, assistant coach, and chaperone. - Information on 4 athletes participating in the event, including their name, date of birth, school, LRN, and contact number. - A table with details of 12 athletes qualified for the Regional Screening and Accreditation Committee Regional Meet, including their name, event, gender, birthdate, school, LRN, and school address. The coach and principal signed off at the bottom to note and prepare the document.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd

    Sample Athletics Records Forms

    Uploaded by

    Halem Laroya Lucernas
    644 views16 pages
    The document contains information about the Cebu Province Sepak Takraw Boys event, including: - The names, schools, and contact details of the coach, assistant coach, and chaperone. - Information on 4 athletes participating in the event, including their name, date of birth, school, LRN, and contact number. - A table with details of 12 athletes qualified for the Regional Screening and Accreditation Committee Regional Meet, including their name, event, gender, birthdate, school, LRN, and school address. The coach and principal signed off at the bottom to note and prepare the document.

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    Sample athletics records forms

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    The document contains information about the Cebu Province Sepak Takraw Boys event, including: - The names, schools, and contact details of the coach, assistant coach, and chaperone. - Information on 4 athletes participating in the event, including their name, date of birth, school, LRN, and contact number. - A table with details of 12 athletes qualified for the Regional Screening and Accreditation Committee Regional Meet, including their name, event, gender, birthdate, school, LRN, and school address. The coach and principal signed off at the bottom to note and prepare the document.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    644 views16 pages

    Sample Athletics Records Forms

    Uploaded by

    Halem Laroya Lucernas
    The document contains information about the Cebu Province Sepak Takraw Boys event, including: - The names, schools, and contact details of the coach, assistant coach, and chaperone. - Information on 4 athletes participating in the event, including their name, date of birth, school, LRN, and contact number. - A table with details of 12 athletes qualified for the Regional Screening and Accreditation Committee Regional Meet, including their name, event, gender, birthdate, school, LRN, and school address. The coach and principal signed off at the bottom to note and prepare the document.

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    © All Rights Reserved
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    You are on page 1of 16

    CEBU PROVINCE

    DIVISION
    SECONDARY
    LEVEL

    SEPAK TAKRAW BOYS


    EVENT

    CERTIFICATE OF EMPLOYMENT
    AFFIDAVIT / SWORN STATEMENT
    PERSONAL DATA SHEET
    MEDICAL CERTIFICATE
    COACH RELEVANT SPORTS TRAINING ASST. COACH
    RELEVANT EXPERIENCE/ RECOGNITION
    APPOINTMENT

    PAREJA JR., ELESITO TAMPUS NAME LUCERNAS, HALEM LAROYA


    CAMOTES NATIONAL HIGH SCHOOL SCHOOL CABONGA-AN NATIONAL HIGH SCHOOL
    9569081928 CONTACT NUMBER 9488537083

    CERTIFICATE OF EMPLOYMENT
    AFFIDAVIT / SWORN STATEMENT
    PERSONAL DATA SHEET
    CHAPERON
    MEDICAL CERTIFICATE

    NAME
    SCHOOL
    CONTACT NUMBER

    AR - 1
    NSO
    FORM - 137
    CERTIFICATE OF ENROLMENT
    ATHLETE1 CERTIFICATE OF COMPLETION ATHLETE 3
    PARENTAL CONSENT
    MEDICAL CERTIFICATE
    DENTAL CERTIFICATE
    INTERVIEWED
    BANO, JHORINE A. NAME OF ATHLETE IMPAS, ALLAN VINCENT
    8/13/2001 DATE OF BIRTH 12/9/2001
    SANTIAGO NATIONAL HIGH SCHOOL SCHOOL SANTIAGO NATIONAL HIGH SCHOOL
    119647120008 LEARNERS REFERENCE NUMBER (LRN) 119652080017
    CONTACT NUMBER
    AR - 1
    NSO
    FORM - 137
    CERTIFICATE OF ENROLMENT
    ATHLETE 2 CERTIFICATE OF COMPLETION ATHLETE 4
    PARENTAL CONSENT
    MEDICAL CERTIFICATE
    DENTAL CERTIFICATE
    INTERVIEWED
    ESTRERA, RETYNAND ACE B. NAME OF ATHLETE LOON, MARK LLOYD
    7/6/2001 DATE OF BIRTH 16-Oct-02
    CAMOTES NATIONAL HIGH SCHOOL SCHOOL CABONGA-AN NATONAL HIGH SCHOOL
    404385150115 LEARNERS REFERENCE NUMBER (LRN) 120002080329
    CONTACT NUMBER
    CEBU PROVINCE
    name of Division
    SAN FRANCISCO
    Name of the Municipality

    NAME BIRTHDATE
    LEVEL EVENT GENDER NAME OF SCHOOL SCHOOL TYPE LRN SCHOOL ADDRESS
    Family Name First Name M.I. mm dd yy
    Secondary Bensig Joseph Anne Margaret S Badminton Female 6 18 2002 Lorenzo C Tanza Memorial NHS Public School 119645080014 Brgy.Union, San Framcisco,Cebu
    Secondary Gonzales BiancaMae P Badminton Female 3 31 2004 CamotesNationalHigh School Public School 11965010073 S.Pob.San Francisco,Cebu
    SECONDARY Macalam Ashanti Francesca B Badminton MALE 1 29 2003 CamotesNationalHigh School Public School 119337080240 S.Pob.San Francisco,Cebu
    SECONDARY Magno Erlin Bea B Badminton MALE 10 16 2002 CABONGA-AN NHS Public School 119650100100 S.Pob.San Francisco,Cebu

    Prepared by: NOTED:


    JULIOUS A.DEMAKILING TONY T. APLACADOR
    District Sports Coordinator District Supervisor
    Regional Screening and Accreditation Committee
    REGIONAL MEET 2018

    Cebu Provincial Meet Venue: Carmen, Cebu


    Date: January 06 - January 12, 2019

    REGION VII
    Name of the Region

    CEBU PROVINCE
    Name of the Division

    NAME BIRTHDATE School


    LEVEL EVENT GENDER Name of school LRN
    Family Name First Name M.I. mm dd yy Type
    1 SECONDARY BANO , JHORINE A. SEPAK TAKRAW BOYS MALE 8 13 2001 SANTIAGO NHS NATIONAL HIGH SCHOOL 119647120008

    2 SECONDARY ESTRERA , REYNAND ACE B. SEPAK TAKRAW BOYS MALE 7 6 2001 CAMOTES NHS NATIONAL HIGH SCHOOL 404385150115
    3 SECONDARY IMPAS , ALLAN VINCENT SEPAK TAKRAW BOYS MALE 12 9 2001 SANTIAGO NHS NATIONAL HIGH SCHOOL 119652080017
    4 SECONDARY LOON , MARK LLOYD SEPAK TAKRAW BOYS MALE 10 16 2002 CABONGA-AN NHS NATIONAL HIGH SCHOOL 120002080329

    5 SECONDARY LUCERNAS , LEE MAR L. SEPAK TAKRAW BOYS MALE 8 22 2001 CAMOTES NHS NATIONAL HIGH SCHOOL 119650070085

    6 SECONDARY LUCERO , ELGE E. SEPAK TAKRAW BOYS MALE 9 13 2001 CAMOTES NHS NATIONAL HIGH SCHOOL 119650070090

    7 SECONDARY MANATAD , CHARLES IVAN E. SEPAK TAKRAW BOYS MALE 9 23 2004 CAMOTES NHS NATIONAL HIGH SCHOOL 119655090028

    8 SECONDARY NUDALO , BENJIE E. SEPAK TAKRAW BOYS MALE 3 3 2002 CAMOTES NHS NATIONAL HIGH SCHOOL 119654070064

    9 SECONDARY ROTA , CHRISTIAN DAVE M. SEPAK TAKRAW BOYS MALE 7 3 2001 SANTIAGO NHS NATIONAL HIGH SCHOOL 119652070026

    10 SECONDARY TAGALOG JR. , ROMEL M. SEPAK TAKRAW BOYS MALE 11 29 2003 CABONGA-AN NHS NATIONAL HIGH SCHOOL 119645090101

    11 SECONDARY VALEROSO , JOEY M. SEPAK TAKRAW BOYS MALE 4 2 2001 CABONGA-AN NHS NATIONAL HIGH SCHOOL 119645070100

    12 SECONDARY WENCESLAO , CLARENCE L. SEPAK TAKRAW BOYS MALE 8 29 2001 SANTIAGO NHS NATIONAL HIGH SCHOOL 119652070029

    Prepared by:
    ELESITO T. PAREJA JR.
    (Coach)

    Noted by:
    ROMEO N. FORMENTERA
    (Principal II)
    ng and Accreditation Committee

    REGION VII
    Name of the Region

    CEBU PROVINCE
    Name of the Division

    School
    Address
    SANTIAGO, SAN FRANCISCO, CEBU
    SO. POB. SAN FRANCISCO, CEBU
    SANTIAGO, SAN FRANCISCO, CEBU
    CABONGA-AN, SAN FRANCISCO , CEBU
    SO. POB. SAN FRANCISCO, CEBU
    SO. POB. SAN FRANCISCO, CEBU
    SO. POB. SAN FRANCISCO, CEBU
    SO. POB. SAN FRANCISCO, CEBU
    SANTIAGO, SAN FRANCISCO, CEBU
    CABONGA-AN, SAN FRANCISCO , CEBU
    CABONGA-AN, SAN FRANCISCO , CEBU
    SANTIAGO, SAN FRANCISCO, CEBU
    CEBU PROVINCE
    DIVISION
    SECONDARY
    LEVEL
    SEPAK TAKRAW BOYS
    EVENT
    AR - 1
    NSO
    FORM - 137
    CERTIFICATE OF ENROLMENT
    ATHLETE 5 CERTIFICATE OF COMPLETION ATHLETE 9
    PARENTAL CONSENT
    MEDICAL CERTIFICATE
    DENTAL CERTIFICATE
    INTERVIEWED
    LUCERNAS, LEE MAR L. NAME OF ATHLETE ROTA, CHRISTIAN DAVE M.
    22-Aug-01 DATE OF BIRTH 3-Jul-01
    CAMOTES NATIONAL HIGH SCHOOL SCHOOL SANTIAGO NATIONAL HIGH SCHOOL
    119650070085 LEARNERS REFERENCE NUMBER (LRN) 119652070026
    CONTACT NUMBER
    AR - 1
    NSO
    FORM - 137
    CERTIFICATE OF ENROLMENT
    ATHLETE 6 CERTIFICATE OF COMPLETION ATHLETE 10
    PARENTAL CONSENT
    MEDICAL CERTIFICATE
    DENTAL CERTIFICATE
    INTERVIEWED
    LUCERO, ELGE E. NAME OF ATHLETE TAGALOG JR., ROMEL M.
    13-Sep-01 DATE OF BIRTH 29-Nov-03
    CAMOTES NATIONAL HIGH SCHOOL SCHOOL CABONGA-AN NATIONAL HIGH SCHOOL
    119650070090 LEARNERS REFERENCE NUMBER (LRN) 119645090101
    CONTACT NUMBER
    AR - 1
    NSO
    FORM - 137
    CERTIFICATE OF ENROLMENT
    ATHLETE 7 CERTIFICATE OF COMPLETION ATHLETE 11
    PARENTAL CONSENT
    MEDICAL CERTIFICATE
    DENTAL CERTIFICATE
    INTERVIEWED
    MANATAD, CHARLES IVAN E. NAME OF ATHLETE VALEROSO, JOEY M.
    SEPTEMBER 23, 20014 DATE OF BIRTH 2-Apr-01
    CAMOTES NATIONAL HIGH SCHOOL SCHOOL CABONGA-AN NATIONAL HIGH SCHOOL
    119655090028 LEARNERS REFERENCE NUMBER (LRN) 119645070100
    CONTACT NUMBER

    AR - 1
    NSO
    FORM - 137

    CERTIFICATE OF ENROLMENT
    ATHLETE 8 CERTIFICATE OF COMPLETION ATHLETE 12
    PARENTAL CONSENT
    ATHLETE 8 ATHLETE 12

    MEDICAL CERTIFICATE
    DENTAL CERTIFICATE
    INTERVIEWED
    NUDALO, BENJIE E. NAME OF ATHLETE WENCESLAO, CLARENCE L.
    3-Mar-02 DATE OF BIRTH 29-Aug-01
    CAMOTES NATIONAL HIGH SCHOOL SCHOOL SANTIAGO NATIONAL HIGH SCHOOL
    119654070064 LEARNERS REFERENCE NUMBER (LRN) 119652070029
    CONTACT NUMBER
    SEPAK TAKRAW BOYS
    EVENT
    AR - 1
    NSO
    FORM - 137
    CERTIFICATE OF ENROLMENT
    ATHLETE 6 CERTIFICATE OF COMPLETION ATHLETE 10
    PARENTAL CONSENT
    MEDICAL CERTIFICATE
    DENTAL CERTIFICATE
    INTERVIEWED
    IBOT, JUNE NIÑO B. NAME OF ATHLETE LUCERO, ELGE E.
    27-Jun-00 DATE OF BIRTH 13-Sep-01
    CAMOTES NATIONAL HIGH SCHOOL SCHOOL CAMOTES NATIONAL HIGH SCHOOL
    119638060033 LEARNERS REFERENCE NUMBER (LRN) 119650070090
    CONTACT NUMBER
    AR - 1
    NSO
    FORM - 137
    CERTIFICATE OF ENROLMENT
    ATHLETE 7 CERTIFICATE OF COMPLETION ATHLETE 11
    PARENTAL CONSENT
    MEDICAL CERTIFICATE
    DENTAL CERTIFICATE
    INTERVIEWED
    IMPAS, ALLAN VINCENT L. NAME OF ATHLETE NUDALO, BENJIE E.
    9-Dec-01 DATE OF BIRTH 3-Mar-02
    SANTIAGO NATIONAL HIGH SCHOOL SCHOOL CAMOTES NATIONAL HIGH SCHOOL
    119652080017 LEARNERS REFERENCE NUMBER (LRN) 119654070064
    CONTACT NUMBER

    AR - 1
    NSO
    FORM - 137
    CERTIFICATE OF ENROLMENT
    ATHLETE 8 CERTIFICATE OF COMPLETION ATHLETE 12
    PARENTAL CONSENT
    MEDICAL CERTIFICATE
    DENTAL CERTIFICATE
    INTERVIEWED
    LOMBENDENCIO, LOLITO D. NAME OF ATHLETE TAGALOG JR., ROMEL M.
    5-Oct-00 DATE OF BIRTH 29-Nov-03
    LORENZO C. TANZA MNHS SCHOOL CABONGA-AN NATIONAL HIGH SCHOOL
    119645060044 LEARNERS REFERENCE NUMBER (LRN) 119645090101
    CONTACT NUMBER

    AR - 1
    NSO
    FORM - 137
    CERTIFICATE OF ENROLMENT
    ATHLETE 8 CERTIFICATE OF COMPLETION ATHLETE 12
    PARENTAL CONSENT
    MEDICAL CERTIFICATE
    DENTAL CERTIFICATE
    INTERVIEWED
    LUCERNAS, LEE MAR L. NAME OF ATHLETE VALEROSO, JOEY M.
    22-Aug-01 DATE OF BIRTH 2-Apr-01
    CAMOTES NATIONAL HIGH SCHOOL SCHOOL CABONGA-AN NATIONAL HIGH SCHOOL
    119650070085 LEARNERS REFERENCE NUMBER (LRN) 119645070100
    CONTACT NUMBER
    CEBU PROVINCE
    DIVISION
    SECONDARY
    LEVEL

    ATHLETICS BOYS
    EVENT

    AR - 1
    NSO
    FORM - 137
    CERTIFICATE OF ENROLMENT
    ATHLETE 13 CERTIFICATE OF COMPLETION ATHLETE 17
    PARENTAL CONSENT
    MEDICAL CERTIFICATE
    DENTAL CERTIFICATE
    INTERVIEWED
    SUAREZ, ELVIN KEIL NAME OF ATHLETE
    8-Jul-99 DATE OF BIRTH
    VNHS SCHOOL
    117444050075 LEARNERS REFERENCE NUMBER (LRN)
    CONTACT NUMBER
    AR - 1
    NSO
    FORM - 137
    CERTIFICATE OF ENROLMENT
    ATHLETE 14 CERTIFICATE OF COMPLETION ATHLETE 18
    PARENTAL CONSENT
    MEDICAL CERTIFICATE
    DENTAL CERTIFICATE
    INTERVIEWED
    TENERO Jr., ARMANDO R. NAME OF ATHLETE
    25-Apr-99 DATE OF BIRTH
    RTNHS SCHOOL
    1175031050058 LEARNERS REFERENCE NUMBER (LRN)
    9109921300 CONTACT NUMBER
    AR - 1
    NSO
    FORM - 137
    CERTIFICATE OF ENROLMENT
    ATHLETE 15 CERTIFICATE OF COMPLETION ATHLETE 19
    PARENTAL CONSENT
    MEDICAL CERTIFICATE
    DENTAL CERTIFICATE
    INTERVIEWED
    TORMIS, JESSIE P. NAME OF ATHLETE
    AUG. 4, 1999 DATE OF BIRTH
    JLNHS SCHOOL
    117745050033 LEARNERS REFERENCE NUMBER (LRN)
    CONTACT NUMBER
    AR - 1
    NSO
    FORM - 137
    CERTIFICATE OF ENROLMENT
    ATHLETE 16 CERTIFICATE OF COMPLETION ATHLETE 20
    PARENTAL CONSENT
    MEDICAL CERTIFICATE
    DENTAL CERTIFICATE
    INTERVIEWED
    NAME OF ATHLETE
    DATE OF BIRTH
    SCHOOL
    LEARNERS REFERENCE NUMBER (LRN)
    CONTACT NUMBER

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