Revised as of September 26, 2019

AR (ATHLETE RECORD)
REGION X
Region

MISAMIS ORIENTAL
Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: SARDA RUTH JEAN T.

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

Sex: FEMALE Learner Reference Number (LRN) 127866130210 Contact Number

Date of Birth: (mm/dd/yyyy) 11/15/2007 Age: 16 Place of Birth: TAGOLOAN, MIS. OR.
School: CASINGLOT NATIONAL HIGH SCHOOL Grade Level 10
Address of School: CASINGLOT, TAGOLOAN, MISAMIS ORIENTAL
Present Address: CASINGLOT, TAGOLOAN, MISAMIS ORIENTAL
Parents: NUMERIANO P. SARDA JENNIE T. SARDA
Fathers Name Mother/Guardian
Address of Parents/Guardian: CASINGLOT, TAGOLOAN, MISAMIS ORIENTAL

√ . If Yes, kindly fill up the table below

B. Participation in the previous Palarong Pambansa. Yes ____ No _____
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

7/11/2023 BASKETBALL INTRAMURALS SILVER

11/24/2023 BASKETBALL DISTRICT MEET GOLD
11/30/2023 BASKETBALL MUNICIPAL MEET GOLD

(Use separate sheet if necessary)

RUTH JEAN T. SARDA

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)

INTRAMURALS CLAUDINE DIANE T. PAPAURAN

DISTRICT MEET CLAUDINE DIANE T. PAPAURAN
MUNICIPAL MEET CLAUDINE DIANE T. PAPAURAN

(Use separate sheet if necessary)

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)