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AR-I (ATHLETE RECORD)

X-10
Region

ILIGAN CITY DIVISION


Division Latest 1½ x 1½ picture

A. PERSONAL DATA:

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

Sex: Learner Reference Number (LRN)


Date of Birth: (mm/dd/yy) Age: Place of Birth:
School:
Address of School:
Present 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
District Meet
Division/ProvIncial Meet
Regional Meet

(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 Division Sports Coordinator/SGOD Chief
District Meet
Division/Provincial Meet
Regional Meet

(Use separate sheet if necessary)

Screened by:

Division Meet Regional Meet

MERIAM S. OTARRA
(Signature over Printed Name) (Signature over Printed Name)

Date: Date:

FOR PALARONG PAMBANSA ONLY

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