You are on page 1of 11

REGION XIII

REGION
SIARGAO
DIVISION

BASKETBALL - SECONDARY GIRLS


EVENT

CERTIFICATE OF EMPLOYMENT/ CONTRACT OF


SERVICE

AFFIDAVIT / SWORN STATEMENT


PERSONAL DATA SHEET
COACH MEDICAL CERTIFICATE ASST. COACH
CERTIFICATE OF TRAINING
CERT. OF SPORTS MEMBERSHIP
CERT. OF RECOGNITION IN LOWER MEETS

GALAVIA, MANNY NAME


MARIANO MATUGAS NHS SCHOOL
9303793756 CONTACT NUMBER

CERTIFICATE OF EMPLOYMENT
PERSONAL DATA SHEET
MEDICAL CERTIFICATE
CHAPERON
COMMITMENT TO NURTURE

BALE, MAE JOREEN T. NAME


DAPA NATIO SCHOOL
CONTACT NUMBER
AR - 1
NSO
FORM - 137
CERTIFICATE OF ENROLMENT

ATHLETE1 CERTIFICATE OF COMPLETION ATHLETE 3


PARENTAL CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED
BERCELES, BRAINY ROSE C. NAME OF ATHLETE JUSAY, ANGEL KRISHIAMAE M.
12/13/2006 DATE OF BIRTH 12/23/2006
BUHING CALIPAY E. S. SCHOOL SAN ISIDRO CENTRAL E. S.
132193120005 LEARNERS REFERENCE NUMBER (LRN) 132199120180
CONTACT NUMBER
AR - 1
NSO
FORM - 137
CERTIFICATE OF ENROLMENT

ATHLETE 2 CERTIFICATE OF COMPLETION ATHLETE 4


PARENTAL CONSENT
MEDICAL CERTIFICATE

DENTAL CERTIFICATE
INTERVIEWED
ESPINAL, DINA D. NAME OF ATHLETE LUSPE, ALTHEA JEAN ANGEL P.
10/20/2007 DATE OF BIRTH 9/28/2008
TIGASAO ELEM. SCHOOL SCHOOL SAN ISIDRO CENTRAL E. S.
132204130034 LEARNERS REFERENCE NUMBER (LRN) 132199120181
CONTACT NUMBER

REGION XIII
DIVISION
SIARGAO
LEVEL

BASKETBALL - SECONDARY GIRLS


EVENT

AR - 1
NSO
FORM - 137
CERTIFICATE OF ENROLMENT
ATHLETE 5 CERTIFICATE OF COMPLETION ATHLETE 9
PARENTAL CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED
PITAS, JUSHLY E. NAME OF ATHLETE
12/19/2006 DATE OF BIRTH
SAN ISIDRO CENTRAL E. S. SCHOOL
132199120186 LEARNERS REFERENCE NUMBER (LRN)
CONTACT NUMBER
AR - 1
NSO
FORM - 137
CERTIFICATE OF ENROLMENT
ATHLETE 6 CERTIFICATE OF COMPLETION ATHLETE 10
PARENTAL CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED
ROMANO, RYZA A. NAME OF ATHLETE
4/28/2008 DATE OF BIRTH
SAN ISIDRO CENTRAL E. S. SCHOOL
132199130129 LEARNERS REFERENCE NUMBER (LRN)
CONTACT NUMBER
AR - 1
NSO
FORM - 137
CERTIFICATE OF ENROLMENT
ATHLETE 7 CERTIFICATE OF COMPLETION ATHLETE 11
PARENTAL CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED
NAME OF ATHLETE
DATE OF BIRTH
SCHOOL
LEARNERS REFERENCE NUMBER (LRN)
CONTACT NUMBER
AR - 1
NSO
FORM - 137
CERTIFICATE OF ENROLMENT
ATHLETE 8 CERTIFICATE OF COMPLETION ATHLETE 12
PARENTAL CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED
NAME OF ATHLETE
DATE OF BIRTH
SCHOOL
LEARNERS REFERENCE NUMBER (LRN)
CONTACT NUMBER
REGION XIII
DIVISION
SIARGAO
LEVEL

BASKETBALL - SECONDARY GIRLS


EVENT

AR - 1
NSO
FORM - 137
CERTIFICATE OF ENROLMENT
ATHLETE 13 CERTIFICATE OF COMPLETION ATHLETE 17
PARENTAL CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED
NAME OF ATHLETE
DATE OF BIRTH
SCHOOL
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
NAME OF ATHLETE
DATE OF BIRTH
SCHOOL
LEARNERS REFERENCE NUMBER (LRN)
CONTACT NUMBER
AR - 1
NSO
FORM - 137
CERTIFICATE OF ENROLMENT
ATHLETE 15 CERTIFICATE OF COMPLETION ATHLETE 19
PARENTAL CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED
NAME OF ATHLETE
DATE OF BIRTH
SCHOOL
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
SIARGAO
DIVISION
SECONDARY
LEVEL
SWIMMING GIRLS
EVENT

AR - 1
N S O ORIG. & PHOTOCOPY
FORM - 137
CERTIFICATE OF ENROLMENT
ATHLETE 5 CERTIFICATE OF COMPLETION ATHLETE 9
PARENTAL CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED
DAGA-ANG, RAFAEL R. NAME OF ATHLETE MIGULLAS, MARK JICO M.
6/18/2001 DATE OF BIRTH 8/9/2003
DAPA NATIONAL HIGH SCHOOL SCHOOL DAPA NATIONAL HIGH SCHOOL
132137060021 LRN 132186090017
CONTACT NUMBER
AR - 1
N S O ORIG. & PHOTOCOPY
FORM - 137
CERTIFICATE OF ENROLMENT
ATHLETE 6 CERTIFICATE OF COMPLETION ATHLETE 10
PARENTAL CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED
TESADO, RENNEL B. NAME OF ATHLETE SOLLOSO, JONIL A.
10/21/2002 DATE OF BIRTH 2/2/2002
DAPA NATIONAL HIGH SCHOOL SCHOOL DAPA NATIONAL HIGH SCHOOL
132143080032 LRN 132139090168
CONTACT NUMBER
AR - 1
N S O ORIG. & PHOTOCOPY
FORM - 137
CERTIFICATE OF ENROLMENT
ATHLETE 7 CERTIFICATE OF COMPLETION ATHLETE 11
PARENTAL CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED
SUMALINOG, ROSETUM E. NAME OF ATHLETE
7/6/2003 DATE OF BIRTH
DAPA NATIONAL HIGH SCHOOL SCHOOL
122080120086 LRN
CONTACT NUMBER
AR - 1
N S O ORIG. & PHOTOCOPY
FORM - 137
CERTIFICATE OF ENROLMENT
ATHLETE 8 CERTIFICATE OF COMPLETION ATHLETE 12
PARENTAL CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED
SOLLOSO, CRISTIAN A. NAME OF ATHLETE
7/16/2000 DATE OF BIRTH
DAPA NATIONAL HIGH SCHOOL SCHOOL
132139060144 LRN
CONTACT NUMBER
Regional Screening and Accreditation Committee
REGIONAL MEET 2020
Regional Meet Venue: 0
Date: February , 2020

REGION XIII, CARAGA


Name of the Region

SIARGAO
Name of the Division

NAME BIRTHDATE School School


LEVEL EVENT GENDER Name of school LRN
Family Name First Name M.I. mm dd yyyy Type Address
1 Elementary ABANECO , JAY L. BASKKETBALL Male 5 29 2005 MANGAGOY SOUTH ELEM. SCHOOL Public Elem. School 314703100003 Mangagoy, Bislig City
2 Secondary ABELLA , BERTO R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
3 Secondary MAGLASANG , PRINCE LEE R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
4 Secondary FRAN , PIOLO R. Athletics Male 6 26 2006 PLAZA CENTRAL ES Public Elem. School 133345 Mangagoy, Bislig City
5 Secondary BARCENA , PRINCE LEE R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
6 Secondary OLIVEROS , JUAN R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
7 Secondary ODIAS , PRINCE LEE R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
8 Secondary LANZADARES , PRINCE LEE R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
9 Secondary RUTHER , PRINCE LEE R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
10 Secondary BAGUOD , FLORENCIO M Athletics Male 12 12 2012 QUINTOS NHS Public Elem. School 654321 TANDAG CITY
11 Secondary PACOT , PRINCE LEE R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
12 Secondary ABREA , DIANARA K. Athletics Male 10 15 2005 SURIGAO CITY CES Public Elem. School 1234567 Mangagoy, Bislig City
13 Secondary NARISMA , PRINCE LEE R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
14 Secondary NARISMA , PRINCE LEE R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
15 Secondary NARISMA , PRINCE LEE R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
16 Secondary NARISMA , PRINCE LEE R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
17 Secondary NARISMA , PRINCE LEE R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
18 Secondary NARISMA , PRINCE LEE R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
19 Secondary NARISMA , PRINCE LEE R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City
20 Secondary NARISMA , PRINCE LEE R. Athletics Male 9 25 2004 BISLIG CENTRAL ES Public Elem. School 132617 Mangagoy, Bislig City

Prepared by: Checked by: Noted


Coach DSAC Div. PESS Supervisor
BEIS / SCHOOL Contact
Division
ID Number
123456 BISLIG CITY 9019599875
123456 AGUSAN DEL SUR 2022
123456 BISLIG CITY 2022
123456 BISLIG CITY 9199
123456 BISLIG CITY 2022
123456 BISLIG CITY 2022
123456 BISLIG CITY 2022
123456 BISLIG CITY 2022
123456 BISLIG CITY 2022
7890 BISLIG CITY 919
123456 BISLIG CITY 2022
123456 BISLIG CITY 2022
123456 BISLIG CITY 2022
123456 BISLIG CITY 2022
123456 BISLIG CITY 2022
123456 BISLIG CITY 2022
123456 BISLIG CITY 2022
123456 BISLIG CITY 2022
123456 BISLIG CITY 2022
123456 BISLIG CITY 2022

Related Interests