Region III

REGION
City of San Fernando (P)
DIVISION

ATHLETICS SECONDARY GIRLS

EVENT

CERTIFICATE OF EMPLOYMENT
AFFIDAVIT / SWORN STATEMENT
PERSONAL DATA SHEET
MEDICAL CERTIFICATE
Assistant Coach/Chaperon
Coach

Mark C. Briones NAME Ma. Eliza M. Yumul

0935-095-8307 CONTACT NUMBER 0926-189-6140
AECMIS SCHOOL NSDPIS

AR - 1
NSO
FORM - 137
CERTIFICATE OF ENROLMENT
athlete PARENTAL CONSENT athlete
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED
NAME OF ATHLETE
107166090007 LRN /BEIS NO./STUDENT NO. 107166100012
0916-158-1485 CONTACT NUMBER 0950-515-4302
7/18/2004 DATE OF BIRTH 10/15/2004
AECMIS SCHOOL AECMIS

AR - 1
NSO
FORM - 137
CERTIFICATE OF ENROLMENT
athlete PARENTAL CONSENT athlete
MEDICAL CERTIFICATE

DENTAL CERTIFICATE

INTERVIEWED
NAME OF ATHLETE
107166100020 LRN /BEIS NO./STUDENT NO. 107173090043
0936-438-6419 CONTACT NUMBER 0955-284-9306
10/31/2004 DATE OF BIRTH 4/4/2003
AECMIS SCHOOL SVQIS

AR - 1
NSO
FORM - 137
CERTIFICATE OF ENROLMENT

athlete PARENTAL CONSENT athlete

MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED
NAME OF ATHLETE
107170070032 LRN /BEIS NO./STUDENT NO. 107166100043
0955-673-2172 CONTACT NUMBER 0923-959-4578
11/8/2001 DATE OF BIRTH 8/14/2004
NSDPIS SCHOOL AECMIS