Ar (Athlete Record) : Region

Revised as of September 26, 2019
AR (ATHLETE RECORD)
VI
Region
CAPIZ
Latest 1½ x 1½ picture
Division
A. PERSONAL DATA:
Name: OLETE SHANA CRISTA JANINE L

(Last) (First) 0 (M.I.)
Sex: FEMALE Learner Reference Number (LRN) 115604160041 Contact Number 9155874374
Date of Birth: (mm/dd/yyyy) 04-21-2011 Age: 11 Place of Birth: MAMBUSAO, CAPIZ

School: MAMBUSAO ELEMENTARY SCHOOL Grade Level VI
Address of School: CONSOLACION ST., POBLACION PROPER, MAMBUSAO, CAPIZ
Present Address: MARALAG, MAMBUSAO, CAPIZ
Parents: FEDERICO E. OLETE, JR. ROSIEL OLETE
Fathers Name Mother/Guardian
Address of Parents/Guardian: MARALAG, MAMBUSAO, CAPIZ
B. Participation in the previous Palarong Pambansa. Yes ____ No _____ . If Yes, kindly fill up the table below
Year of Participation Sports Event Venue Remarks
C. Athlete's Participation in the Lower Meets (For the Current School Year)
Inclusive Dates Sports Event Athletic Meet Remarks
(Use separate sheet if necessary)
Athlete's Signature over Printed Name
D. Certification on Athlete's Participation

This is to certify that based on our knowledge, the above-mentioned athlete has participated in the lower meets.
Name and Signature of Division Name and Signature of

Meet Name and Signature of Coach
Sports Officer (DSO) Regional Sports Officer (RSO)
Screened by:
Division Meet Regional Meet Palarong Pambansa
(Signature of DSAC over Printed Name) (Signature of RSAC over Printed Name) (Signature of NSAC over Printed Name)
Date: ______________ Date: ______________ Date: ______________
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

AR (ATHLETE RECORD)
VI
Region
CAPIZ
Division
A. PERSONAL DATA:
Name: KAPUNAN VINA V

Date of Birth: (mm/dd/yyyy) 05/02/2011 Age: 11 Place of Birth: MAMBUSAO, CAPIZ

Present Address: REVOLUTION ST. POBLACION TABUC, MAMBUSAO, CAPIZ
Parents: LUDOVICO L. KAPUNAN CHONA V. KAPUNAN
Address of Parents/Guardian: REVOLUTION ST. POBLACION TABUC, MAMBUSAO, CAPIZ


Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
VI
Region
CAPIZ
Division
A. PERSONAL DATA:
Name: PULA BRIANNA ROSE C

Date of Birth: (mm/dd/yyyy) 12/07/2011 Age: 11 Place of Birth: MAMBUSAO, CAPIZ

Present Address: TUGAS, MAMBUSAO, CAPIZ
Parents: LEO B. PULA BELINDA C. PULA
Address of Parents/Guardian: TUGAS, MAMBUSAO, CAPIZ


Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
VI
Region
CAPIZ
Division
A. PERSONAL DATA:
Name: SORNITO PRINCESS GWYN P


School: MAMBUSAO ELEMENTARY SCHOOL Grade Level V
Present Address: SITIO PACOMA, BATO-BATO, MAMBUSAO, CAPIZ
Parents: RITCHE G. SORNITO LUZEL P. SORNITO
Address of Parents/Guardian: SITIO PACOMA, BATO-BATO, MAMBUSAO, CAPIZ


Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
VI
Region
CAPIZ
Division
A. PERSONAL DATA:
Name: GARNACE XANDER CHRYSTIAN V

Sex: MALE Learner Reference Number (LRN) 115604190030 Contact Number 9493476008

School: MAMBUSAO ELEMENTARY SCHOOL Grade Level IV
Present Address: BUNGA, MAMBUSAO, CAPIZ
Parents: ERVING CHRISTIAN N. GARNACE CHRYSTY V. GARNACE
Address of Parents/Guardian: BUNGA, MAMBUSAO, CAPIZ


Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
VI
Region
CAPIZ
Division
A. PERSONAL DATA:
Name: LUCES RONDEL DINO L


Present Address: NAVARRA AVENUE, MAMBUSAO, CAPIZ
Parents: DEO L. LUCES ROSEMARIE L. LUCES
Address of Parents/Guardian: NAVARRA AVENUE, MAMBUSAO, CAPIZ


Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
VI
Region
CAPIZ
Division
A. PERSONAL DATA:
Name: LUZ DAXX RAVEN D


Present Address: ATIPLO, MAMBUSAO, CAPIZ
Parents: EDREX REY A. LUZ SHIELLAH MAY E. DELFIN
Address of Parents/Guardian: ATIPLO, MAMBUSAO, CAPIZ


Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
VI
Region
CAPIZ
Division
A. PERSONAL DATA:
Name: LOZADA GERARD REY P

Date of Birth: (mm/dd/yyyy) 11/30/2011 Age: 10 Place of Birth: ROXAS CITY

Present Address: BULA, MAMBUSAO, CAPIZ
Parents: GARY L. LOZADA CAMELIA RHEA D. LOZADA
Address of Parents/Guardian: BULA, MAMBUSAO, CAPIZ


Screened by:
Date: ______________ Date: ______________ Date: ______________

Ar (Athlete Record) : Region

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Revised as of September 26, 2019

Name: OLETE SHANA CRISTA JANINE L

Date of Birth: (mm/dd/yyyy) 04-21-2011 Age: 11 Place of Birth: MAMBUSAO, CAPIZ

(Use separate sheet if necessary)

Athlete's Signature over Printed Name

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: KAPUNAN VINA V

Date of Birth: (mm/dd/yyyy) 05/02/2011 Age: 11 Place of Birth: MAMBUSAO, CAPIZ

(Use separate sheet if necessary)

Athlete's Signature over Printed Name

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: PULA BRIANNA ROSE C

Date of Birth: (mm/dd/yyyy) 12/07/2011 Age: 11 Place of Birth: MAMBUSAO, CAPIZ

(Use separate sheet if necessary)

Athlete's Signature over Printed Name

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: SORNITO PRINCESS GWYN P

Date of Birth: (mm/dd/yyyy) 11-25-2011 Age: 10 Place of Birth: MAMBUSAO, CAPIZ

(Use separate sheet if necessary)

Athlete's Signature over Printed Name

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: GARNACE XANDER CHRYSTIAN V

Date of Birth: (mm/dd/yyyy) 05-28-2013 Age: 9 Place of Birth: MAMBUSAO, CAPIZ

(Use separate sheet if necessary)

Athlete's Signature over Printed Name

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: LUCES RONDEL DINO L

Date of Birth: (mm/dd/yyyy) 11-19-2010 Age: 11 Place of Birth: MAMBUSAO, CAPIZ

(Use separate sheet if necessary)

Athlete's Signature over Printed Name

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: LUZ DAXX RAVEN D

Date of Birth: (mm/dd/yyyy) 07-31-2011 Age: 11 Place of Birth: MAMBUSAO, CAPIZ

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __