Revised as of APRIL 3, 2023 XI

REGION
SCHOOLS DIVISION OF DAVAO DEL NORTE
DIVISION

BASKETBALL GIRLS (SECONDARY)

EVENT

COACH/ASST. COACH RECORD

A.
B. APPOINTMENT / EMPLOYMENT / CONTRACT OF SERVICE
C. OMNIBUS AFFIDAVIT
Coach D. MEDICAL CERTIFICATE Assistant Coach
E. CERTIFICATE OF TRAINING
F. CERTIFICATE OF SPORTS MEMBERSHIP
G. LICENSE OR CERTIFICATIONS/ACCREDITATION

MILITANTE, JOSEPH T. NAME

STO. TOMAS NATIONAL HIGH SCHOOL SCHOOL

A. APPOINTMENT / EMPLOYMENT / CONTRACT OF SERVICE

B. CERTIFICATE OF COMMITMENT
C. MEDICAL CERTIFICATE

Chaperon

BELTRAN, MARITES P. NAME

STO. TOMAS NATIONAL HIGH SCHOOL SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

ABAN, ELAIZA L. NAME OF ATHLETE ANDAGAN, GLAZY MAE H.

128765110001 LRN 128753120030
5/10/2006 DATE OF BIRTH 11/14/2006
STO. TOMAS NATIONAL HIGH SCHOOL SCHOOL STO. TOMAS NATIONAL HIGH SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

ALTERADO, CRISTALIE D. NAME OF ATHLETE DELGADO, SHAIRA JOY M.

128750140015 LRN 128765100336
2/11/2008 DATE OF BIRTH 6/6/2005
STO. TOMAS NATIONAL HIGH SCHOOL SCHOOL STO. TOMAS NATIONAL HIGH SCHOOL

NOTE:
PLEASE USE A4 SIZE COPY PAPER

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Interviewed by: Approved:

_______________________ ATTY. LORENZA C. PITULAN

RSAC Member RSAC CHAIRPERSON
Date:___________ Date: __________
Revised as of APRIL 3, 2023 XI
REGION
SCHOOLS DIVISION OF DAVAO DEL NORTE
DIVISION

BASKETBALL GIRLS (SECONDARY)

EVENT

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

DESTACAMENTO, CHARMY ROSE S. NAME OF ATHLETE MUNINIO, LYNLEE ROSE C.

128765120082 LRN 128758110029
10/25/2006 DATE OF BIRTH 10/12/2006
STO. TOMAS NATIONAL HIGH SCHOOL SCHOOL STO. TOMAS NATIONAL HIGH SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

ESPEJO, SOPHIA CARMINA V. NAME OF ATHLETE PANES, JHAI C.

128659140133 LRN 128765121255
10/18/2008 DATE OF BIRTH 02/25/2006
STO. TOMAS NATIONAL HIGH SCHOOL SCHOOL STO. TOMAS NATIONAL HIGH SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

MANLIGUIS, DIESA JANE C. NAME OF ATHLETE SERAN, REGINA CARLA C.

132353120012 LRN 128765130800
9/17/2007 DATE OF BIRTH 09/19/2008
STO. TOMAS NATIONAL HIGH SCHOOL SCHOOL STO. TOMAS NATIONAL HIGH SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

MIPANGCAT, NAJERA S. NAME OF ATHLETE TAGHOY, SOPHIA YSABEL B.

128765170742 LRN 464517150044
2/9/2006 DATE OF BIRTH 11/14/2006
STO. TOMAS NATIONAL HIGH SCHOOL SCHOOL STO. TOMAS NATIONAL HIGH SCHOOL

NOTE:
PLEASE USE A4 SIZE COPY PAPER

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

. Revised as of APRIL 3, 2023 XI
REGION
ISLAND GARDEN CITY OF SAMAL
DIVISION

EVENT

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

NOTE:
PLEASE USE A4 SIZE COPY PAPER

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)