Republic of the Philippines

DEPARTMENT OF EDUCATION

REGION XI

D A V A O C I T Y
Division

COLUMBUS ELEMENTARY SCHOOL

(School)
Buda, Marilog District, Davao City
(School Address)

________________

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent participation of my/our son/daughter
__________________________________ Line Meet.

I have considered the benefits that my son or daughter will derive from his/her participation in this
activity provided that due care and precaution will observed to ensure the comfort and safety of my son/daughter
and that DepED Employees and personnel may not be held responsible for any untoward incident that may
happen beyond their control.

_________________________________ __________________________________________
Signature of Father Signature of Mother

________________________________ ___________________ .
Name of Father Name of Mother

____________________________________
Signature of Guardian Over Printed Name

_____________________________________
(Relationship with the Athlete)
Verified by:

_______________ RUTHLYN H.SUMANDANG, Ph.D

Adviser Principal 1

Remarks
FOR PALARONG PAMBANSA

Republic of the Philippines

DEPARTMENT OF EDUCATION

REGION XI

D A V A O C I T Y
Division

MALABOG CENTRAL ELEMENTARY SCHOOL

(School)
Malabog, Paquibato District, Davao City
(School Address)

MEDICAL CERTIFICATE

January 3, 2019

To Whom It May Concern:

This is to certify that I have personally examined JOHN RODS A. BONGCAYAT age 11 sex Male

born on August 7, 2007 and have found that he/she is physically fit, during the time of examination,

to join and compete in the lower meets and Palarong Pambansa.

Event: Track and Field

Physical Examination

Date examined: ______________________

Height ____141cm___________ Weight _____28kg______Blood Pressure ____90/60________
Pulse Rating ___________93_______________________ Respiratory Rate ________________
Other Remarks ___________________________________________________________________
________________Fit______________________________________________
___________________________________________________________________

_________________________________
Physician/Medical Officer

License No. ___________________

PTR: _________________________
Date: ________________________
FOR PALARONG PAMBANSA
Republic of the Philippines
DEPARTMENT OF EDUCATION

REGION XI

D A V A O C I T Y
Division

CATALUNAN PEQUEŇO ELEMENTARY SCHOOL

(School)
Catalunan Pequeňo, Davao City
(School Address)

January 3, 2019

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent participation of my/our son RODNY C.
YAMYAMIN in the Division, Regional Meet and Palarong Pambansa.

I have considered the benefits that my son or daughter will derive from his/her participation in this
activity provided that due care and precaution will observed to ensure the comfort and safety of my son/daughter
and that DepED Employees and personnel may not be held responsible for any untoward incident that may
happen beyond their control.

_________________________________ __________________________________________
Signature of Father Signature of Mother

_______ROGELIO YAMYAMIN_________ MARILOU YAMYAMIN .

Name of Father Name of Mother

____________________________________
Signature of Guardian Over Printed Name

__________________________
(Relationship with the Athlete)
Verified by:

ASUNCION S. INFIESTO .
Principal II

Remarks:
FOR PALARONG PAMBANSA

Republic of the Philippines

DEPARTMENT OF EDUCATION

REGION XI

D A V A O C I T Y
Division

CATALUNAN PEQUEŇO ELEMENTARY SCHOOL

(School)
Catalunan Pequeňo, Davao City
(School Address)

MEDICAL CERTIFICATE

January 3, 2019

To Whom It May Concern:

This is to certify that I have personally examined RODNY C. YAMYAMIN age 11 sex MALE

born on FEBRUARY 24, 2007 and have found that he/she is physically fit, during the time of examination,

to join and compete in the lower meets and Palarong Pambansa.

Event: TRACK AND FIELD

Physical Examination

Date examined: ______________________

Height ______154cm______ Weight _______50kg______Blood Pressure ____________
Pulse Rating ________58bpm________________________ Respiratory Rate ___14cpm______
Other Remarks ________________________________________________________
_______physically fit__________________________________________________
___________________________________________________________________

_________________________________
Physician/Medical Officer

License No. ___________________

PTR: _________________________
Date: ________________________
FOR PALARONG PAMBANSA
Republic of the Philippines
DEPARTMENT OF EDUCATION

REGION XI

D A V A O C I T Y
Division

CATALUNAN PEQUEŇO ELEMENTARY SCHOOL

(School)
Catalunan Pequeňo, Davao City
(School Address)

January 3, 2019

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent participation of my/our son BENZ KLIEN M.
LAROZA in the Division, Regional Meet and Palarong Pambansa.

I have considered the benefits that my son will derive from his/her participation in this activity
provided that due care and precaution will observed to ensure the comfort and safety of my son and that DepED
Employees and personnel may not be held responsible for any untoward incident that may happen beyond their
control.

_________________________________ __________________________________________
Signature of Father Signature of Mother

______BIMBO LAROZA__________ GLYNES LAROZA .

Name of Father Name of Mother

____________________________________
Signature of Guardian Over Printed Name

__________________________
(Relationship with the Athlete)
Verified by:

ASUNCION S. INFIESTO .
Principal II

Remarks:
FOR PALARONG PAMBANSA

Republic of the Philippines

DEPARTMENT OF EDUCATION

REGION XI

D A V A O C I T Y
Division

CATALUNAN PEQUEŇO ELEMENTARY SCHOOL

(School)
Catalunan Pequeňo, Davao City
(School Address)

MEDICAL CERTIFICATE

January 3, 2019

To Whom It May Concern:

This is to certify that I have personally examined BENZ KLIEN M. LAROZA age 12 sex MALE

born on _JANUARY 5, 2006_ and have found that he/she is physically fit, during the time of examination,

to join and compete in the lower meets and Palarong Pambansa.

Event: TRACK AND FIELD_

Physical Examination

Date examined: ______________________

Height _____156cm__________ Weight _____58kg______Blood Pressure __________________
Pulse Rating ______________________________________ Respiratory Rate _____14cpm___________
Other Remarks ___________________________________________________________
____________physically fit____________________________________________
___________________________________________________________________

_________________________________
Physician/Medical Officer

License No. ___________________

PTR: _________________________
Date: ________________________
FOR PALARONG PAMBANSA

Republic of the Philippines

DEPARTMENT OF EDUCATION

REGION XI

D A V A O C I T Y
Division

CATALUNAN PEQUENO ELEMENTARY SCHOOL

(School)
Catalunan Pequeno, Davao City
(School Address)

January 3, 2019

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent participation of my/our son HENRY C.
SASUMAN in the Division, Regional Meet and Palarong Pambansa.

I have considered the benefits that my son will derive from his/her participation in this activity
provided that due care and precaution will observed to ensure the comfort and safety of my son and that DepED
Employees and personnel may not be held responsible for any untoward incident that may happen beyond their
control.

_________________________________ __________________________________________
Signature of Father Signature of Mother

_________________________________ ERMA SASUMAN .

Name of Father Name of Mother

____________________________________
Signature of Guardian Over Printed Name

__________________________
(Relationship with the Athlete)
Verified by:

ASUNCION S. INFIESTO .
Principal II
 Remarks:

FOR PALARONG PAMBANSA

Republic of the Philippines
DEPARTMENT OF EDUCATION

REGION XI

D A V A O C I T Y
Division

CATALUNAN PEQUENO ELEMENTARY SCHOOL

(School)
Catalunan Pequeno, Davao City
(School Address)

MEDICAL CERTIFICATE

January 3, 2019

To Whom It May Concern:

This is to certify that I have personally examined HENRY C. SASUMAN age 12 sex MALE

born on MAY 11, 2006 and have found that he/she is physically fit, during the time of examination,

to join and compete in the lower meets and Palarong Pambansa.

Event: TRACK AND FIELD

Physical Examination

Date examined: ______________________

Height _______145cm__________ Weight __41kg_________Blood Pressure ___________
Pulse Rating _____54bpm__________________________ Respiratory Rate ____14cpm____
Other Remarks ___________________________________________________________________
_____________physically fit___________________________________________________
___________________________________________________________________

_________________________________
Physician/Medical Officer

License No. ___________________

 PTR: _________________________
Date: ________________________

FOR PALARONG PAMBANSA

Republic of the Philippines
DEPARTMENT OF EDUCATION

REGION XI

D A V A O C I T Y
Division
Columbus Elementary School
(School)
Buda, Marilog District, Davao Cit
(School Address)

MEDICAL CERTIFICATE

January 3, 2019

To Whom It May Concern:

This is to certify that I have personally examined MERRY GRACE B. QUITAIN__ age __38__

sex FEMALE born on JUNE 2, 1980 and have found that he/she is physically fit, during the time of

examination, to join and compete in the lower meets and Palarong Pambansa.

Event: Coach- TRACK AND FIELD BOYS

Physical Examination

Date examined: ______________________

Height _____5’1__________ Weight ____52kg__________Blood Pressure ____110/60_____
Pulse Rating _________________82_____________________ Respiratory Rate _________24_______
Other Remarks ______________________________________________________________________
______Fit to play_______________________________________
___________________________________________________________________

_________________________________
Physician/Medical Officer

License No. ___________________

 PTR: _________________________
Date: ________________________

FOR PALARONG PAMBANSA

Republic of the Philippines
DEPARTMENT OF EDUCATION

REGION XI

D A V A O C I T Y
Division
Columbus Elementary School
(School)
Buda, Marilog District, Davao Cit
(School Address)

MEDICAL CERTIFICATE

January 3, 2019

To Whom It May Concern:

This is to certify that I have personally examined JAN ANTHONY A. ARMECIN_ age __32__
Name
sex MALE born on January 18, 1986 and have found that he/she is physically fit, during the time of

examination,to join and compete in the lower meets and Palarong Pambansa.

Event: Second Coach-TRACK AND FIELD BOYS

Physical Examination

Date examined: ______________________

Height _____5’3___________ Weight ____61kg__________Blood Pressure ____120/90_____
Pulse Rating ____________84__________________________ Respiratory Rate ________________
Other Remarks __________82__________________________________________________
______fit___________________________________________________________
___________________________________________________________________

_________________________________
Physician/Medical Officer
 License No. ___________________
PTR: _________________________
Date: ________________________

FOR PALARONG PAMBANSA