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IV-A CALABARZON

REGION
BATANGAS
DIVISION

BASKETBALL
EVENT

COACH/ASST. COACH/CHAPERON RECORD


(CERTIFICATE OF TRAINING, RELEVANT COACHING EXPERIENCE )
CONTRACT OF SERVICE (FOR PRIVATE)
OMNIBUS AFFIDAVIT
Coach MEDICAL CERTIFICATE Assistant Coach/Chaperon
CERTIFICATE OF COMMITMENT (for Chaperon)

NORMAN M. LUMALANG NAME PHILIP N. RESURRECCION


SAN GREGORIO ANNEX SCHOOL SAN GREGORIO ANNEX
ELEMENTARY SCHOOL ELEMENTARY SCHOOL
AR - 1
ORIGINAL COPY OF PSA/NSO
SF 10 / FORM - 137
CERTIFICATE OF ATTENDANCE
PARENTS CONSENT
athlete athlete
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
CABELLO, ANJHEL H. DE VILLA, GIAN CARL O.
DISABILITY ASSESSMENT
GRADE VI GRADE VI
INTERVIEWED

CABELLO, ANJHEL H. NAME OF ATHLETE DE VILLA GIAN CARL O.


107382130001 LRN 107382130005
3/13/2008 DATE OF BIRTH 7/4/2008
SAN GREGORIO ANNEX SCHOOL SAN GREGORIO ANNEX
ELEMENTARY SCHOOL ELEMENTARY SCHOOL
AR - 1
ORIGINAL COPY OF PSA/NSO
SF 10 / FORM - 137
CERTIFICATE OF ATTENDANCE
PARENTS CONSENT
athlete athlete
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
CANTERO, DARWIN A. DE VILLA JOHN AERON C.
DISABILITY ASSESSMENT GRADE V
GRADE VI
INTERVIEWED

CANTERO, DARWIN A. NAME OF ATHLETE DE VILLA JOHN AERON C.


107382130002 LRN 107382140004
7/16/2008 DATE OF BIRTH 12/15/2008
SAN GREGORIO ANNEX SCHOOL SAN GREGORIO ANNEX
ELEMENTARY SCHOOL ELEMENTARY SCHOOL
AR - 1
ORIGINAL COPY OF PSA/NSO
SF 10 / FORM - 137
CERTIFICATE OF ATTENDANCE
PARENTS CONSENT
athlete athlete
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
CASTILLO ANDREN P. DISABILITY ASSESSMENT
DE VILLA, MARK LISTER C.
GRADE VI GRADE VI
INTERVIEWED

CASTILLO, ANDREN P. NAME OF ATHLETE DE VILLA MARK LISTER C.


1073820004 LRN 107382130006
8/29/2008 DATE OF BIRTH 9/10/2008
SAN GREGORIO ANNEX SCHOOL SAN GREGORIO ANNEX
ELEMENTARY SCHOOL ELEMENTARY SCHOOL
NOTE: FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
IV-A CALABARZON
REGION
BATANGAS
DIVISION
BASKETBALL
EVENT
AR - 1
ORIGINAL COPY OF PSA/NSO
SF 10 / FORM - 137
CERTIFICATE OF ATTENDANCE
PARENTS CONSENT
athlete athlete
MEDICAL CERTIFICATE
DE VILLA MIKE DAREN N. DENTAL CERTIFICATE
GRADE VI DISABILITY ASSESSMENT MEDINA, MENARD M.
GRADE VI
INTERVIEWED

DE VILLA MIKE DAREN N. NAME OF ATHLETE MEDINA, MENARD M.


107382130007 LRN 107382130011
4/25/2008 DATE OF BIRTH 6/11/2007
SAN GREGORIO ANNEX E/S SCHOOL SAN GREGORIO ANNEX E/S
AR - 1
ORIGINAL COPY OF PSA/NSO
SF 10 / FORM - 137
CERTIFICATE OF ATTENDANCE
athlete athlete
PARENTS CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
GARCIA, MARC GIAN KARL C. YABUT, ARVIN C.
GRADE VI DISABILITY ASSESSMENT
GRADE VI
INTERVIEWED

GARCIA, MARC GIAN KARL C NAME OF ATHLETE YABUT ARVIN C.


107382130008 LRN 107382130014
11/9/2008 DATE OF BIRTH 6/12/2007
SAN GREGORIO ANNEX E/S SCHOOL SAN GREGORIO ANNEX E/S
AR - 1
ORIGINAL COPY OF PSA/NSO
SF 10 / FORM - 137
CERTIFICATE OF ATTENDANCE
athlete athlete
PARENTS CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
MAPALAD, DENRICK LEE A. DISABILITY ASSESSMENT
GRADE V
INTERVIEWED

MAPALAD, DENRICK LEE A. NAME OF ATHLETE


107382140007 LRN
5/29/2009 DATE OF BIRTH
SAN GREGORIO ANNEX E/S SCHOOL
AR - 1
ORIGINAL COPY OF PSA/NSO
SF 10 / FORM - 137
CERTIFICATE OF ATTENDANCE
athlete athlete
PARENTS CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
MEDINA, LENARD M. DISABILITY ASSESSMENT
GRADE VI INTERVIEWED

MEDINA LENARD M. NAME OF ATHLETE


107382130010 LRN
6/11/2007 DATE OF BIRTH
SAN GREGORIO ANNEX E/S SCHOOL

NOTE:
PLEASE USE A4 SIZE COPY PAPER FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
REGION

DIVISION

EVENT

AR - 1
ORIGINAL COPY OF PSA/NSO
SF 10 / FORM - 137
CERTIFICATE OF ATTENDANCE
athlete athlete
PARENTS CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
DISABILITY ASSESSMENT
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

AR - 1
ORIGINAL COPY OF PSA/NSO
SF 10 / FORM - 137
CERTIFICATE OF ATTENDANCE
athlete athlete
PARENTS CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
DISABILITY ASSESSMENT
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

AR - 1
ORIGINAL COPY OF PSA/NSO
SF 10 / FORM - 137
CERTIFICATE OF ATTENDANCE
athlete athlete
PARENTS CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
DISABILITY ASSESSMENT
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

AR - 1
ORIGINAL COPY OF PSA/NSO
SF 10 / FORM - 137
CERTIFICATE OF ATTENDANCE
athlete athlete
PARENTS CONSENT
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
DISABILITY ASSESSMENT
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL
NOTE:
PLEASE USE A4 SIZE COPY PAPER

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