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    Coach Athlete: Event

    Uploaded by

    Kimberley Tadeo
    The document contains eligibility requirements for athletes participating in a basketball 3x3 event, including an athlete's record, government identification documents, medical certificates, and consent forms. It lists four athletes - Johnrey T. Ybanez in Grade 9, James Kyle E. Cagang in Grade 11, Emmanuel Davey M. Camus in Grade 10, and Niel John A. Secuya - along with their details and schools. A coach, Kero Roy C. Tadeo, and chaperone, James Kyle E. Cagang, are also listed.

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

    Coach Athlete: Event

    Uploaded by

    Kimberley Tadeo
    32 views15 pages
    The document contains eligibility requirements for athletes participating in a basketball 3x3 event, including an athlete's record, government identification documents, medical certificates, and consent forms. It lists four athletes - Johnrey T. Ybanez in Grade 9, James Kyle E. Cagang in Grade 11, Emmanuel Davey M. Camus in Grade 10, and Niel John A. Secuya - along with their details and schools. A coach, Kero Roy C. Tadeo, and chaperone, James Kyle E. Cagang, are also listed.

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    The document contains eligibility requirements for athletes participating in a basketball 3x3 event, including an athlete's record, government identification documents, medical certificates, and consent forms. It lists four athletes - Johnrey T. Ybanez in Grade 9, James Kyle E. Cagang in Grade 11, Emmanuel Davey M. Camus in Grade 10, and Niel John A. Secuya - along with their details and schools. A coach, Kero Roy C. Tadeo, and chaperone, James Kyle E. Cagang, are also listed.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    32 views15 pages

    Coach Athlete: Event

    Uploaded by

    Kimberley Tadeo
    The document contains eligibility requirements for athletes participating in a basketball 3x3 event, including an athlete's record, government identification documents, medical certificates, and consent forms. It lists four athletes - Johnrey T. Ybanez in Grade 9, James Kyle E. Cagang in Grade 11, Emmanuel Davey M. Camus in Grade 10, and Niel John A. Secuya - along with their details and schools. A coach, Kero Roy C. Tadeo, and chaperone, James Kyle E. Cagang, are also listed.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    You are on page 1of 15

    Revised as of September 26, 2019 VIII

    REGION
    ORMOC CITY
    DIVISION

    BASKETBALL 3X3 (BOYS)


    EVENT

    A. AR (ATHLETE'S RECORD)

    B. ORIGINAL COPY OF PSA/NSO


    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    Coach E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY Athlete
    F. MEDICAL CERTIFICATE
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    KERO ROY C. TADEO INTERVIEWED
    COACH

    NAME OF ATHLETE JOHNREY T. YBANEZ


    LRN 124155140150
    DATE OF BIRTH 2/21/2006
    SCHOOL IPIL NATIONAL HIGH SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    Chaperon F. MEDICAL CERTIFICATE
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    JAMES KYLE E. CAGANG NAME OF ATHLETE


    124160120002 LRN
    9/13/2006 DATE OF BIRTH
    IPIL NATIONAL HIGH SCHOOL SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    EMMANUEL DAVEY M. CAMUS NAME OF ATHLETE


    124161120066 LRN
    3/14/2007 DATE OF BIRTH
    IPIL NATIONAL HIGH SCHOOL SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete
    F. MEDICAL CERTIFICATE
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    NIEL JOHN A. SECUYA NAME OF ATHLETE


    LRN
    DATE OF BIRTH
    IPIL NATIONAL HIGH SCHOOL SCHOOL
    NOTE: PLEASE USE A4 SIZE COPY PAPER
    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
    Revised as of September 26, 2019 VIII
    REGION
    ORMOC CITY
    DIVISION

    BASKETBALL 3X3 (BOYS)


    EVENT

    A. AR (ATHLETE'S RECORD)

    B. ORIGINAL COPY OF PSA/NSO


    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    Coach E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY Athlete
    F. MEDICAL CERTIFICATE
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    KERO ROY C. TADEO INTERVIEWED JOHNREY T. YBANEZ
    COACH GRADE 9

    NAME OF ATHLETE JOHNREY T. YBANEZ


    LRN 124155140150
    DATE OF BIRTH 2/21/2006
    SCHOOL IPIL NATIONAL HIGH SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    Chaperon F. MEDICAL CERTIFICATE
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    JAMES KYLE E. CAGANG INTERVIEWED
    GRADE 11

    JAMES KYLE E. CAGANG NAME OF ATHLETE


    124160120002 LRN
    9/13/2006 DATE OF BIRTH
    IPIL NATIONAL HIGH SCHOOL SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    EMMANUEL DAVEY M. CAMUS INTERVIEWED
    GRADE 10

    EMMANUEL DAVEY M. CAMUS NAME OF ATHLETE


    124161120066 LRN
    3/14/2007 DATE OF BIRTH
    IPIL NATIONAL HIGH SCHOOL SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete
    F. MEDICAL CERTIFICATE
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    NIEL JOHN A. SECUYA
    GRADE 10 INTERVIEWED

    NIEL JOHN A. SECUYA NAME OF ATHLETE


    LRN
    DATE OF BIRTH
    IPIL NATIONAL HIGH SCHOOL SCHOOL
    NOTE: PLEASE USE A4 SIZE COPY PAPER
    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
    Revised as of September 26, 2019 VIII
    REGION
    ORMOC CITY
    DIVISION

    BASKETBALL 5X5 (BOYS)


    EVENT

    A. AR (ATHLETE'S RECORD)

    B. ORIGINAL COPY OF PSA/NSO


    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    Coach E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY Athlete
    F. MEDICAL CERTIFICATE
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    NAME OF ATHLETE ALEXIS JID P. DANOSA


    LRN 124155100073
    DATE OF BIRTH 2/25/2005
    SCHOOL IPIL NATIONAL HIGH SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    Chaperon F. MEDICAL CERTIFICATE
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    IVAN J. CANETE NAME OF ATHLETE RAVEN P. ESOTO


    124155130215 LRN 124169100035
    3/21/2008 DATE OF BIRTH 5/7/2005
    IPIL NATIONAL HIGH SCHOOL SCHOOL IPIL NATIONAL HIGH SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    ALVIN JOHN E. DAISOG NAME OF ATHLETE LLOYD ANDREI M. GATOC


    124168100020 LRN 124155100094
    2/18/2005 DATE OF BIRTH 3/12/2005
    IPIL NATIONAL HIGH SCHOOL SCHOOL IPIL NATIONAL HIGH SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E.
    athlete PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete
    F. MEDICAL CERTIFICATE
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    JOHN LEON DAISOG NAME OF ATHLETE CHARLIE P. GORGONIO


    124169120044 LRN
    12/15/2006 DATE OF BIRTH 7/29/2006
    IPIL NATIONAL HIGH SCHOOL SCHOOL IPIL NATIONAL HIGH SCHOOL
    NOTE: PLEASE USE A4 SIZE COPY PAPER
    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
    Revised as of September 26, 2019 VIII
    REGION
    ORMOC CITY
    DIVISION

    BASKETBALL 5X5 (BOYS)


    EVENT

    A. AR (ATHLETE'S RECORD)

    B. ORIGINAL COPY OF PSA/NSO


    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    Coach E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY Athlete
    F. MEDICAL CERTIFICATE
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    KERO ROY C. TADEO INTERVIEWED ALEXIS JID P. DANOSA
    COACH GRADE 12

    NAME OF ATHLETE ALEXIS JID P. DANOSA


    LRN 124155100073
    DATE OF BIRTH 2/25/2005
    SCHOOL IPIL NATIONAL HIGH SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    Chaperon F. MEDICAL CERTIFICATE
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    IVAN J. CANETE INTERVIEWED RAVEN P. ESOTO
    GRADE 9 GRADE 12

    IVAN J. CANETE NAME OF ATHLETE RAVEN P. ESOTO


    124155130215 LRN 124169100035
    3/21/2008 DATE OF BIRTH 5/7/2005
    IPIL NATIONAL HIGH SCHOOL SCHOOL IPIL NATIONAL HIGH SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    ALVIN JOHN E. DAISOG INTERVIEWED LLOYD ANDREI M. GATOC
    GRADE 12 GRADE 11

    ALVIN JOHN E. DAISOG NAME OF ATHLETE LLOYD ANDREI M. GATOC


    124168100020 LRN 124155100094
    2/18/2005 DATE OF BIRTH 3/12/2005
    IPIL NATIONAL HIGH SCHOOL SCHOOL IPIL NATIONAL HIGH SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E.
    athlete PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete
    F. MEDICAL CERTIFICATE
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only) CHARLIE P. GORGONIO
    JOHN LEON DAISOG
    GRADE 10 INTERVIEWED GRADE 11

    JOHN LEON DAISOG NAME OF ATHLETE CHARLIE P. GORGONIO


    124169120044 LRN
    12/15/2006 DATE OF BIRTH 7/29/2006
    IPIL NATIONAL HIGH SCHOOL SCHOOL IPIL NATIONAL HIGH SCHOOL
    NOTE: PLEASE USE A4 SIZE COPY PAPER
    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
    Revised as of September 26, 2019 VIII
    REGION
    ORMOC CITY
    DIVISION

    BASKETBALL 5X5 (BOYS)


    EVENT

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    JEDREK Z. JUNTILLA NAME OF ATHLETE ARLOU D. ROBLE


    LRN 124195110138
    10/13/2007 DATE OF BIRTH 4/9/2006
    IPIL NATIONAL HIGH SCHOOL SCHOOL IPIL NATIONAL HIGH SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    VAN AUGUSTINE C. MALLEN NAME OF ATHLETE


    124155100132 LRN
    8/11/2005 DATE OF BIRTH
    IPIL NATIONAL HIGH SCHOOL SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    STEPHEN S. PAGALAN NAME OF ATHLETE


    LRN
    7/1/2006 DATE OF BIRTH
    IPIL NATIONAL HIGH SCHOOL SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    LAURENCE JOSHUA C. PELICANO NAME OF ATHLETE


    LRN
    5/28/2005 DATE OF BIRTH
    IPIL NATIONAL HIGH SCHOOL SCHOOL
    Revised as of September 26, 2019 VIII
    REGION
    ORMOC CITY
    DIVISION

    BASKETBALL 5X5 (BOYS)


    EVENT

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    JEDREK Z. JUNTILLA INTERVIEWED ARLOU D. ROBLE
    GRADE 9 GRADE 12

    JEDREK Z. JUNTILLA NAME OF ATHLETE ARLOU D. ROBLE


    LRN 124195110138
    10/13/2007 DATE OF BIRTH 4/9/2006
    IPIL NATIONAL HIGH SCHOOL SCHOOL IPIL NATIONAL HIGH SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    VAN AUGUSTINE C. MALLEN INTERVIEWED
    GRADE 10

    VAN AUGUSTINE C. MALLEN NAME OF ATHLETE


    124155100132 LRN
    8/11/2005 DATE OF BIRTH
    IPIL NATIONAL HIGH SCHOOL SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    STEPHEN S. PAGALAN INTERVIEWED
    GRADE 10

    STEPHEN S. PAGALAN NAME OF ATHLETE


    LRN
    7/1/2006 DATE OF BIRTH
    IPIL NATIONAL HIGH SCHOOL SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    LAURENCE JOSHUA C. PELICANO INTERVIEWED
    GRADE 12

    LAURENCE JOSHUA C. PELICANO NAME OF ATHLETE


    LRN
    5/28/2005 DATE OF BIRTH
    IPIL NATIONAL HIGH SCHOOL SCHOOL
    . Revised as of September 26, 2019 VIII
    REGION
    ORMOC CITY
    DIVISION

    BASKETBALL 5X5
    EVENT

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    NAME OF ATHLETE
    LRN
    DATE OF BIRTH
    SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    NAME OF ATHLETE
    LRN
    DATE OF BIRTH
    SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    NAME OF ATHLETE
    LRN
    DATE OF BIRTH
    SCHOOL

    A. AR (ATHLETE'S RECORD)
    B. ORIGINAL COPY OF PSA/NSO
    C. SF 10 / FORM - 137
    D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
    E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
    athlete F. MEDICAL CERTIFICATE
    athlete
    G. DENTAL CERTIFICATE
    H. DISABILITY ASSESSMENT (for PARAGAMES Only)
    INTERVIEWED

    NAME OF ATHLETE
    LRN
    DATE OF BIRTH
    SCHOOL
    NOTE: PLEASE USE A4 SIZE COPY PAPER
    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

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