Revised as of APRIL 3, 2023 ILOCOS REGION

REGION
SCHOOLS DIVISION OF ILOCOS NORTE
DIVISION
VOLLEYBALL BOYS - SECONDARY

EVENT

A. COACH/ASST. COACH RECORD

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

ACEDO, RICARDO JR. B. NAME ARIBATO, ADRIAN G.

BANNA ACADEMY INC. SCHOOL BANNA ACADEMY INC.
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

ACOSTA, KLYVE ALMIR F. NAME OF ATHLETE ANTONIO, AGRESOR JR N.

100243120002 LRN 100074140021
9/21/2006 DATE OF BIRTH 3/28/2009
BANNA ACADEMY INC. SCHOOL BANNA ACADEMY INC.

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
INTERVIEWED

AGUILAR, VINCENT GIAN G. NAME OF ATHLETE BINGAN, NORIEL T.

100074140009 LRN 1000157120003
7/4/2009 DATE OF BIRTH 1/12/2007
BANNA ACADEMY INC. SCHOOL BANNA ACADEMY INC.

NOTE:
PLEASE USE A4 SIZE COPY PAPER

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Revised as of September 26, 2019 I
REGION
ILOCOS NORTE
DIVISION

VOLLEYBALL BOYS - 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

GRANIADA, DEXTER R. NAME OF ATHLETE SAHAGUN, JHUROSS P.

1000107110009 LRN 100074120008
1/11/2006 DATE OF BIRTH 7/30/2007
BANNA ACADEMY INC. SCHOOL BANNA ACADEMY INC.

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

HERMANO, JASPER G. NAME OF ATHLETE SINCO, JOSEPH CARLO S.

10007413005 LRN 100072120009
1/23/2008 DATE OF BIRTH 5/4/2007
BANNA ACADEMY INC. SCHOOL BANNA ACADEMY INC.

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

LACABA, IAN ALBERT M. NAME OF ATHLETE SOSA, CARE JAMES R.

100243120002 LRN 100060110014
10/18/2007 DATE OF BIRTH 4/22/2006
BANNA ACADEMY INC. SCHOOL BANNA ACADEMY INC.

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

NAPICOG, DHARELL JAMES S. NAME OF ATHLETE ZAFARALLA, PRINCE ERICK A.

10006130006 LRN 1002431330003
2/14/2008 DATE OF BIRTH 12/7/2008
BANNA ACADEMY INC. SCHOOL BANNA ACADEMY INC.

NOTE:
PLEASE USE A4 SIZE COPY PAPER

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

.
REGION

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 (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 (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 (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

NOTE:
PLEASE USE A4 SIZE COPY PAPER
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)