REPUBLIC OF THE PHILIPINES

Department of Education
REGION V
DIVISION OF CATANDUANES
Virac, Catanduanes

CHECKLIST
EVENT:

Affidavit of Sworn Disability

FORM
Athlete Original Parental Statement of Med. Med. Dental Assessment (for Coach/Asst.
NAME OF ATHLETES 137 / SF Appointment
Record NSO/PSA Consent Actual Care & Cert 1 Cert 2 Cert. PARAGAMES Coach Record
10
Custody Only)
1
2

COACH

ASST. COACH
CHAPERON

PREPARED AND SUBMITTED BY: Received by:

COACH
Date:
Omnibus Medical
REMARKS
Affidavit Cert.
AR (ATHLETE'S RECORD)

ORIGINAL COPY OF PSA/NSO

SF 10 / FORM - 137

CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)

PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY

MEDICAL CERTIFICATE

DENTAL CERTIFICATE

DISABILITY ASSESSMENT (for PARAGAMES Only)