AR-I (ATHLETE RECORD)

### VIII
Region

Latest 1½ x 1½
picture
TACLOBAN CITY
Division
A. PERSONAL DATA:

Name: SALUBON JOHN MICHAEL R.

(Last) (First) (M.I.)

Sex: MALE Learner Reference Number (LRN) 124245170068 Contact Number: *09851657248
Date of Birth: (mm/dd/yy) 11/4/2011 Age: 11 Place of Birth: TACLOBAN CITY
School: DR. A. P. BAÑEZ MEMORIAL ELEMENTARY SCHOOL Grade & Sec. 5 - PERIDOT
Address of School: BRGY. 77, BAÑEZ VILLE II, TACLOBAN CITY Adviser: MA CRISTINITA M. PABRO
Home Address: BRGY. 77, BAÑEZ VILLE II, TACLOBAN CITY
Parents: MICHAEL D. SALUBON CAMILLE M. REQUILLAS
Fathers Name Mother/Guardian
Address of Parents: BRGY. 77, BAÑEZ VILLE II, TACLOBAN CITY

B. Athlete's Participation in Local/International Competition

Inclusive Dates Sports Event Athletic Meet Remarks
CHESS - ELEMENTARY BOYS INTRAMURALS WINNER
CHESS - ELEMENTARY BOYS DISTRICT MEET WINNER
03/17-20/2023 CHESS - ELEMENTARY BOYS CITY MEET WINNER
CHESS - ELEMENTARY BOYS EVRAA 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 PESS Supervisor/s Signature
INTRAMURALS
DISTRICT MEET
CITY MEET DEXTER A. EMNAS JESSICA P. MACAWILE-ABRIL
EVRAA MEET JESSICA P. MACAWILE-ABRIL

(Use separate sheet if necessary)

Screened by:

Division Meet Regional Meet

(Signature over Printed Name) (Signature over Printed Name)