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Revised as of April 3, 2023

REGION

DIVISION

EVENT
A. COACH / ASST. COACH RECORD

B. APPOINTMENT (PUBLIC) / CONTRACT OF SERVICE (PRIVATE)


C. OMNIBUS AFFIDAVIT
D. MEDICAL CERTIFICATE
Coach E
Assistant Coach
CERTIFICATE OF TRAINING
F CERTIFICATE OF SPORTS MEMBERSHIP

G LICENSE OR CERTIFICATE OF ACCREDITATION

NAME
SCHOOL

A. APPOINTMENT (PUBLIC) / CONTRACT OF SERVICE (PRIVATE)


B. CERTIFICATE OF COMMITMENT
C. MEDICAL CERTIFICATE

Chaperon

NAME
SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA / NSO
C. School Form 10
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL
E.
CARE & CUSTODY
athlete athlete
F. MEDICAL CERTIFICATE
G. DENTAL CERTIFICATE
H. 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. School Form 10
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL
E.
CARE & CUSTODY
athlete athlete
F. MEDICAL CERTIFICATE
G. DENTAL CERTIFICATE
H. 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)
Revised as of April, 2023 I I I - CENTRAL LUZON
REGION

DIVISION

EVENT
A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. School Form 10
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF
E.
athlete ACTUAL CARE & CUSTODY athlete
F. MEDICAL CERTIFICATE
G. DENTAL CERTIFICATE
H. 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. School Form 10
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)

E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF


athlete ACTUAL CARE & CUSTODY athlete
F. MEDICAL CERTIFICATE
G. DENTAL CERTIFICATE
H. 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. School Form 10
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL
E.
CARE & CUSTODY
athlete athlete
F. MEDICAL CERTIFICATE
G. DENTAL CERTIFICATE
H. 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. School Form 10
D.CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL
E.
CARE & CUSTODY
athlete athlete
F. MEDICAL CERTIFICATE
G. DENTAL CERTIFICATE
H. 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)

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