AR-I (ATHLETE RECORD)

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District

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School Latest 1½ x 1½ picture

A. PERSONAL DATA:

Name:
(Last) (First) (M.I.)

Sex: Learner Reference Number (LRN) Contact Number:

Date of Birth:
(mm/dd/yy) Age: Place of Birth:
School: BEIS (Private School Number )

Address of School:
Home Address:
Parents:
Fathers Name Mother/Guardian
Address of Parents:

B. Athlete's Participation in Local/International Competition

Inclusive Dates Sports Event Athletic Meet Remarks

(Use separate sheet if necessary)

Athlete's Signature
C. Athlete's Participation
This is to certify that based on our knowledge the above-mentioned athlete has participated
in the lower meets.
Athletic meet Name of Coach Signature District/High School PESS Coordinator
Zone/Cluster Meet
Palarong Pambayan
Palarong Panlalawigan

(Use separate sheet if necessary)

Screened by:

Municipal Screening and Accreditation Committee Division Screening Chairman

(Signature over Printed Name) (Signature over Printed Name)

Date: Date: