Arnis Men

REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF EDUCATION
SOCCSKSARGEN
KIDAPAWAN CITY DIVISION
ATHLETES DOCUMENT
*IMPORTANT*
1. FILL ALL ATHLETE'S DATA ATHLETE 1 CUSTADO ATHLETE 10 0
ATHLETE 2 MALANTAWAN ATHLETE 11 0
ATHLETE 3 MARCELINO ATHLETE 12 0
*PRINTING* ATHLETE 4 CAMANDERO ATHLETE 13 0
1. CLICK ATHLETE 1, ETC… ATHLETE 5 CEDEÑO ATHLETE 14 0
2. HIT Ctrl. + P. ATHLETE 6 ALMONARES III ATHLETE 15 0
3. Hit ENTER ATHLETE 7 0 ATHLETE 16 0
* COACHES & CHAPERON REQUIREMENTS ARE IN THE GALLERY. ATHLETE 8 0 ATHLETE 17 0
ATHLETE 9 0 ATHLETE 18 0
* ALL ENTRIES MUST BE IN CAPITAL LETTERS*
GALLERY MC-1
Certificate of Completion
UNPROTECT-R
RONALD S. RAMONES-KIDAPAWAN CITY
S
N
UMENTS
ATHLETES DATA
PLACE ALL ENTRIES

HERE
ID PICTURES
Note: FOR GYMNASTICS AND COMBATIVE SPORTS ONLY

Submit the necessary documents, i.e. Affidavit/Sworn Statement of Actual Care and Custody duly verified
by the adviser and school head, in case signature of other parent is unavailable.
IF DECEASED, SECURE DEATH CERTIFICATE.

Revised as of September 26, 2019 Republic of the Philippines Revised as of September 26, 2019
DEPARTMENT OF EDUCATION D
SOCCSKSARGEN
Region
COTABATO
Division
PIGCAWAYAN NATIONAL HIGH SCHOOL
School
POBLACION 2, PIGCAWAYAN, COTABATO
School Address
CERTIFICATE OF COMPLETION
Date:
To Whom It May Concern: To Whom It May Concer
This is to certify that CUSTADO, NIGEL T. has completed
the Grade/Year (Elementary/Secondary Level) for the School Yea . the Grade/Year
RICKY S. FLORES, PI
School Head/Registrar
(Signature Over Printed Name)
Revised as of September 26, 2019 Revised as of September 26, 2019
SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
Date:
This is to certify that MALANTAWAN, HAMSA J. has completed
RICKY S. FLORES, PI
SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
Date:
This is to certify that MARCELINO, JONY A. has completed
RICKY S. FLORES, PI
Revised as of September 26, 2019 Republic of the Philippines Revised as of September 26, 2019 Repu
DEPARTMENT OF EDUCATION DEPART
SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
Date:
To Whom It May Concern: To Whom It May Concern:
This is to certify that CAMANDERO, CRISTIAN D. has completed This is to certify that
RICKY S. FLORES, PI
Revised as of September 26, 2019 Revised as of September 26, 2019

SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
Date:
This is to certify that CEDEÑO, SEYAN PATRICK L. has completed This is to certify that
RICKY S. FLORES, PI
SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
Date:
This is to certify that ALMONARES III, RICHARD F. has completed This is to certify that
RICKY S. FLORES, PI
of September 26, 2019 Republic of the Philippines Revised as of September 26, 2019 Republic of the
DEPARTMENT OF EDUCATION DEPARTMENT OF
SOCCSKSARGEN SOCCSKSA
Region
COTABATO COTABA
Division
PIGCAWAYAN NATIONAL HIGH SCHOOL PIGCAWAYAN NATION
School
POBLACION 2, PIGCAWAYAN, COTABATO POBLACION 2, PIGCAW
School Address
CERTIFICATE OF COMPLETION CERTIFICATE O
Date:
m It May Concern: To Whom It May Concern:
This is to certify that 0 has completed This is to certify that
Grade/Year (Elementary/Secondary Level) for the School Yea . the Grade/Year
0
of September 26, 2019 Revised as of September 26, 2019

Region
COTABATO COTABA
Division
School
School Address
Date:
0
Region
COTABATO COTABA
Division
School
School Address
Date:
0
Republic of the Philippines Revised as of September 26, 2019 Republic of the Philippine
DEPARTMENT OF EDUCATION DEPARTMENT OF EDUCA
SOCCSKSARGEN SOCCSKSARGEN
Region Region
COTABATO COTABATO
Division Division
PIGCAWAYAN NATIONAL HIGH SCHOOL PIGCAWAYAN NATIONAL HIGH S
School School
POBLACION 2, PIGCAWAYAN, COTABATO POBLACION 2, PIGCAWAYAN, COT
School Address School Address
CERTIFICATE OF COMPLETION CERTIFICATE OF COM
Date:
To Whom It May Concern:
0 has completed This is to certify that ,
(Elementary/Secondary Level) for the School Yea . the Grade/Year (Elementary/Secondary L
0
Revised as of September 26, 2019

Region Region
COTABATO COTABATO
Division Division
School School
Date:
, has completed This is to certify that ,
0
Region Region
COTABATO COTABATO
Division Division
School School
Date:
0
Republic of the Philippines Revised as of September 26, 2019 Republic of the Philippines
EPARTMENT OF EDUCATION DEPARTMENT OF EDUCATION
Region Region
COTABATO COTABATO
Division Division
GCAWAYAN NATIONAL HIGH SCHOOL PIGCAWAYAN NATIONAL HIGH SCHOOL
School School
BLACION 2, PIGCAWAYAN, COTABATO POBLACION 2, PIGCAWAYAN, COTABATO
IFICATE OF COMPLETION CERTIFICATE OF COMPLETI
Date:
(Elementary/Secondary Level) for the School Yea . the Grade/Year (Elementary/Secondary Level) for t
0
School Head/Registrar School H

Region Region
COTABATO COTABATO
Division Division
School School
Date:
0
Region Region
COTABATO COTABATO
Division Division
School School
Date:
0
c of the Philippines HOME
ENT OF EDUCATION
OCCSKSARGEN
Region
COTABATO
Division
N NATIONAL HIGH SCHOOL
School
PIGCAWAYAN, COTABATO
chool Address
TE OF COMPLETION
Date:
, has completed
ntary/Secondary Level) for the School Yea .
0
c of the Philippines
ENT OF EDUCATION
OCCSKSARGEN
Region
COTABATO
Division
School
chool Address
TE OF COMPLETION
Date:
, has completed
0
c of the Philippines
ENT OF EDUCATION
OCCSKSARGEN
Region
COTABATO
Division
School
chool Address
TE OF COMPLETION
Date:
, has completed
0
BACK
YEAR Region Level Event Last Name First Name
1 2024 XII 7 ARNIS CUSTADO NIGEL
7 2024 XII ARNIS MALANTAWAN HAMSA
8 2024 XII 8 ARNIS MARCELINO JONY
9 2024 XII 9 ARNIS CAMANDERO CRISTIAN
10 2024 XII 7 ARNIS CEDEÑO SEYAN PATRICK
11 2024 XII 8 ARNIS ALMONARES III RICHARD
11 2024 XII
12 2019 XII
13 2019 XII
14 2019 XII
15 2019 XII
16 2019 XII
17 2019 XII
18 2019 XII
COACH
CO-COACH
CHAPERON
REGION SOCCSKSARGEN
DIVISION COTABATO Name of Coach
DATE
PRC LICENSE PTR NO.
DENTIST
DOCTOR
DSO
RSO
MI Sex Bdate mm/dd/yyyy Schoolname School Type
T. MALE April 20, 2011 PIGCAWAYAN NATIONAL HIGH SCHOOL URBAN
J. MALE November 08, 2007 PIGCAWAYAN NATIONAL HIGH SCHOOL URBAN
A. MALE June 02, 2010 PIGCAWAYAN NATIONAL HIGH SCHOOL URBAN
D. MALE December 24, 2008 PIGCAWAYAN NATIONAL HIGH SCHOOL URBAN
L. MALE May 20, 2011 PIGCAWAYAN NATIONAL HIGH SCHOOL URBAN
F. MALE January 10, 2009 PIGCAWAYAN NATIONAL HIGH SCHOOL URBAN
Athletic Meet REMARKS Remarks-PARENTAL CONSENT (A1)

INTRAMURALS
UNICIPAL MEET
Y/DIVISION MEET
SRAA MEET
Remarks-PARENTAL CONSENT (A2)

School Address SchDiv school code LRN
POBLACION 2, PIGCAWAYAN, COTABATO COTABATO 124 130273160004

ARENTAL CONSENT (A1) Remarks-PARENTAL CONSENT (A6)

PLACE OF BIRTH FATHER MOTHER
SOUTH MANUANGAN, PIGCAWAYAJESRELL M. CUSTADO HELJANE R. TAUB
TUBON, PIGCAWAYA, COTABATO PATAO A. MALANTAWAN JULIET J. MALANTAWAN
LEBAK, SULTAN, KUDARAT MARIO D. MARCELINO LADY ANN M. ANGCOL
MIDPAPAN 2, PIGCAWAYAN, COT JOSE RUFO A. CAMANDERO ERMANITA L. DOBLE
CAPAYURAN, PIGCAWAYAN, COTABATO ARO CEDEÑO
MARIKINA CTY RICHARD E. ALMONARES JR. SHERYL D. FRANCISCO

GUARDIAN RELATIONSHIP HOME ADDRESS
SOUTH MANUANGAN, PIGCAWAYAN, COTABATO
TUBON, PIGCAWAYAN, COTABATO
BINLOAN, PIGCAWAYAN, COTABATO
MIDPAPAN 2, PIGCAWAYAN, COTABATO
CAPAYURAN, PIGCAWAYAN, COTABATO
MIDPAPAN 2, PIGCAWAYAN, COTABATO
Remarks-PARENTAL CONSENT (A1)7

ADDRESS OF PARENTS/GUARDIAN GRADE SECTION AGE ADVISER
SOUTH MANUANGAN, PIGCAWAYAN, COTABATO 7 JOAQUIN 12 SHEENA MAY PACETE
TUBON, PIGCAWAYAN, COTABATO 10 BELL 16 ANGELIE D. JAGONOD
BINLOAN, PIGCAWAYAN, COTABATO 8 CAROLUS 13 JOAN JOY S. SIBYA
MIDPAPAN 2, PIGCAWAYAN, COTABATO 9E 15
CAPAYURAN, PIGCAWAYAN, COTABATO 7I 12 JASMINE DUMALAOG
MIDPAPAN 2, PIGCAWAYAN, COTABATO 8 CAROLUS 15 JOAN JOY S. SIBYA
124
124
124
124
124
124
124
124
124
124
124
124
124
124
124
INCLUSIVE
REGISTRAR/PRINCIPAL SCHOOL YEAR INTRAMURALS KIPRISAA MEET
RICKY S. FLORES, PI 2023-2024 NOVEMBER 13-18, 2023
INCLUSIVE DATES
CITY/DIVISION MEET SRAA MEET Contact Number
9975806440
9354744274
9810323517
PARTCIPATION IN PREVIOUS PALA
Contact Number Year of Participation Sports Event
9975806440
9354744274
9810323517
ARTCIPATION IN PREVIOUS PALARONG PAMBANSA
Venue Remarks
marks
Revised as of September 26, 2019 SOCCSKSARGEN
REGION
COTABATO
DIVISION
ARNIS
EVENT
COACH/ASST. COACH RECORD

A. (CERTIFICATE OF TRAINING, RELEVANT COACHING EXPERIENCE )
B. APPOINTMENT (PUBLIC) / CONTRACT OF SERVICE (PRIVATE)
C. OMNIBUS AFFIDAVIT
D. MEDICAL CERTIFICATE Assistant Coach/Co-Coach
COACH COACH/ASST.COACH
, NAME ,
0 SCHOOL 0
CERTIFICATE OF COMMITMENT
MEDICAL CERTIFICATE
CHAPERON
CHAPERON
, NAME
0 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)
athlete
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete
F. MEDICAL CERTIFICATE
G. DENTAL CERTIFICATE
H. DISABILITY ASSESSMENT (for PARAGAMES Only)
NIGEL T. CUSTADO INTERVIEWED JONY MARCELINO
A1 7-J A3 8-C
CUSTADO, NIGEL T. NAME OF ATHLETE MARCELINO, JONY A.
130273160004 LRN 131112160073
April 20, 2011 DATE OF BIRTH June 02, 2010
PIGCAWAYAN NATIONAL HIGH SCHOOL SCHOOL PIGCAWAYAN NATIONAL HIGH SCHOOL
C. SF 10 / FORM - 137
athlete
A2 E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
HAMSA MALANTAWAN INTERVIEWED
A2 10-B A4
MALANTAWAN, HAMSA J. NAME OF ATHLETE CAMANDERO, CRISTIAN D.
130300130009 LRN 130280130009
November 08, 2007 DATE OF BIRTH December 24, 2008
PIGCAWAYAN NATIONAL HIGH SCHOOL SCHOOL PIGCAWAYAN NATIONAL HIGH SCHOOL
NOTE:
PLEASE USE A4 SIZE COPY PAPER

REGION
COTABATO
DIVISION
ARNIS
EVENT
C. SF 10 / FORM - 137
athlete E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete
INTERVIEWED
A5 A9
CEDEÑO, SEYAN PATRICK L. NAME OF ATHLETE 0
131240160281 LRN 0
May 20, 2011 DATE OF BIRTH December 30, 1899
PIGCAWAYAN NATIONAL HIGH SCHOOL SCHOOL 0
C. SF 10 / FORM - 137
athlete athlete
INTERVIEWED
A6 A10
ALMONARES III, RICHARD F. NAME OF ATHLETE 0
130274150001 LRN 0
January 10, 2009 DATE OF BIRTH December 30, 1899
PIGCAWAYAN NATIONAL HIGH SCHOOL SCHOOL 0
C. SF 10 / FORM - 137
athlete athlete
INTERVIEWED
A7 A11
0 NAME OF ATHLETE ,
0 LRN 0
December 30, 1899 DATE OF BIRTH December 30, 1899
0 SCHOOL 0
C. SF 10 / FORM - 137
athlete athlete
INTERVIEWED
A8 A12
0 NAME OF ATHLETE ,
0 LRN 0
0 SCHOOL 0
NOTE:

REGION
COTABATO
DIVISION
ARNIS
EVENT
C. SF 10 / FORM - 137
athlete athlete
INTERVIEWED
A13 A17
, NAME OF ATHLETE ,
0 LRN 0
0 SCHOOL 0
C. SF 10 / FORM - 137
athlete athlete
INTERVIEWED
A14 A18
, NAME OF ATHLETE ,
0 LRN 0
0 SCHOOL 0
C. SF 10 / FORM - 137
athlete athlete
INTERVIEWED
A15
, NAME OF ATHLETE
0 LRN
December 30, 1899 DATE OF BIRTH
0 SCHOOL
C. SF 10 / FORM - 137
athlete athlete
INTERVIEWED
A16
, NAME OF ATHLETE
0 LRN
December 30, 1899 DATE OF BIRTH
0 SCHOOL
NOTE:
BACK
H
BACK
NIGEL T. CUSTADO
7-J
A1 A7 A13
HAMSA MALANTAWAN
10-B
A2 A8 A14
JONY MARCELINO
8-C
A3 A9 A15
A4 A10 A16
A5 A11 A17
A6 A12 A18
COACH COACH/ASST.COACH CHAPERON
CONVERT YOUR PICTURE FROM "JPEG" TO
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Revised as of September 26, 2019 Republic of the Philippines MCForm - 1
SOCCSKSARGEN
Region
DivisionCOTABATO
Division
Division
0
School
0
School Address
MEDICAL CERTIFICATE
This is to certify that I have personally examined 0
age 124 sex 0 , and have found that he/she is physically fit unfit,
during the time of examination, to join and participate in the lower meets up to Palarong Pambansa.
Event: 0
Physical Examination
School/Intrams/ Unit/Division Meet Regional Meet Palarong Pambansa
District Meet
Normal Normal Normal Normal
1. Eyes YES NO YES NO YES NO YES NO
2. Ears, Nose, Throat YES NO YES NO YES NO YES NO
3. Mouth and Teeth YES NO YES NO YES NO YES NO
4. Neck YES NO YES NO YES NO YES NO
5. Cardiovascular YES NO YES NO YES NO YES NO
6. Chest and Lungs YES NO YES NO YES NO YES NO
7. Abdomen YES NO YES NO YES NO YES NO
8. Skin YES NO YES NO YES NO YES NO
9. Genitalia-Hernia (male) YES NO YES NO YES NO YES NO
10. Muskuloskeletal: ROM YES NO YES NO YES NO YES NO
a. neck YES NO YES NO YES NO YES NO
b. spine YES NO YES NO YES NO YES NO
c. shoulder YES NO YES NO YES NO YES NO
d. arms/hands YES NO YES NO YES NO YES NO
e. hips YES NO YES NO YES NO YES NO
f. thighs YES NO YES NO YES NO YES NO
g. knees YES NO YES NO YES NO YES NO
h. ankles YES NO YES NO YES NO YES NO
i. feet YES NO YES NO YES NO YES NO
11. Neuromuscular (reflexes) YES NO YES NO YES NO YES NO
School/Intrams/District Meet Remarks/Findings:
0 Ht . Cm FIT
Physician/Medical Officer Wt: kg
(signature over printed name) BP: mmHg UNFIT
PRC PR: bpm
LICENSE: 0 PTR NO. 0 RR: cpm Date:
Unit/Division Meet Remarks/Findings:
0 Ht . Cm FIT
PRC PR: bpm
Regional Meet Remarks/Findings:
0 Ht . Cm FIT
PRC PR: bpm
Palarong Pambansa Remarks/Findings:
Ht . Cm FIT
PRC PR: bpm
LICENSE: PTR NO. RR: cpm Date:
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
This form must be completed and signed by the parent/guardian, prior to the physical examination, for review by examining
practitioner. Explain ‘YES’ answers below with number of the question.
YES NO REMARKS
34. Have you ever had a history of seizure (convulsion)? YES NO
35. Do you have headaches with exercise? YES NO
36. Have you ever had numbness, tingling or weakness in your arms or legs after being YES NO
hit or falling?
37. Have you ever been unable to move your arms or legs after being hit or YES NO
falling?
38. Have you ever become ill after exercising in the heat? YES NO
39. Do you get frequent muscles cramps when exercising? YES NO
40. Have you had any problems with your eyes or vision? YES NO
41. Have you had any eye injuries? YES NO
42. Do you wear glasses or contact lens? YES NO
43. Do you wear protective eyewear such as goggles or face shield? YES NO
44. Do you have any concerns that you would like to discuss with a doctor? YES NO
45. Have you ever recieved dengvaxia vaccine? If Yes, how many dose? YES NO
46. Do you have G6PD (Glucose 6 Phosphate Dehydrogenase) condition? YES NO
FEMALES ONLY YES NO
47. Have you ever had a menstrual period? YES NO
48. Have you ever had mestrual cramps? YES NO
49. How old were you when you had your first menstrual period? YES NO
50. How many menstrual periods have you had in the last year? YES NO
NOTES:
I do not know of any existing physical or addition health reason that would preclude participation in sports. I certify that the answers to
the above questions are true and accurate and I approve participation in the athletic activities.
JESRELL M. CUSTADO HELJANE R. TAUB CUSTADO, NIGEL T.

Parent/Guardian Signature over Printed Name Athlete Signature over Printed Name
Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
YES NO REMARKS
36. Have you ever had numbness, tingling or weakness in your arms or legs after being hit YES NO
or falling?
YES NO
37. Have you ever been unable to move your arms or legs after being hit or falling?
FEMALES ONLY YES NO
NOTES:
PATAO A. MALANTAWAN JULIET J. MALANTAWAN MALANTAWAN, HAMSA J.

Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
Athlete’s Name: MARCELINO, JONY A. Date of Examination:

Birthdate: June 02, 2010
MEDICAL HISTORY
GENERAL QUESTIONS YES NO REMARKS
1. Has a doctor ever denied or restricted your participation in sports for any reason or told you to
give up sports? YES NO
2. Do you have an ongoing medical condition (like diabetes, asthma, anemia, infarctions, allergy)? YES NO
3. Are you currently taking any prescription or nonprescription (over-the-counter) YES NO

medicines or pills?
4. Do you have allergies to medicines, pollens, foods or stinging insects? YES NO
5. Have you ever spent the night in a hospital? YES NO
6. Have you ever had surgery? YES NO
HEART HEALTH QUESTIONS ABOUT YOU
7. Have you ever passed out or nearly passed out DURING exercise? YES NO
8. Have you ever passed out or nearly passed out AFTER exercise? YES NO
9. Have you ever had discomfort pain, tightness or pressure in your chest during exercise? YES NO
10. Does your heart race or skip beats (irregular beats) during exercise? YES NO
11. Has a doctor ever ordered a test for your heart? (ECG/EKG, echocardiogram, stress test) YES NO
12.Do you get tightheaded or feel more short of breath than expected during exercise? YES NO
13. Have you ever had an unexplained seizure? YES NO
14. Do you get more tired or short of breath more quickly than your friends during exercise? YES NO
HEART HEALTH QUESTIONS ABOUT YOUR FAMILY
15. Has any family member or relative died of heart problems or had an unexpected or
unexplained sudden deaths before the age of 50 (including unexplained drowning, YES NO
unexplained car accident, or sudden infant syndrome)
16. Has anyone in your family had unexplained fainting, unexplained seizures or near drowning? YES NO
BONE AND JOINT QUESTIONS
17. Have you ever had an injury, like sprain, muscle or ligament tear or tendonitis that YES NO
caused you to miss a practice or game?
18. Have you had any broken or fractured bones or dislocated joints? YES NO
19. have you ever had an injury that requires x-ray for neck instability? YES NO
20. Do you regularly use a brace or other assistive device? YES NO
21. Do you have a bone, muscle or joint injury that bothers you? YES NO
22. Do any of your joints become painful, swollen, feel warm or look red? YES NO
MEDICAL QUESTIONS YES NO
23. Has a doctor ever told you that you have asthma or allergies?
24. Do you cough, wheeze, experience chest tightness, or have difficulty breathing during YES NO
or after exercise?
25. Is there anyone in your family who has asthma? YES NO
26. Have you ever used an inhaler or taken asthma medicine? YES NO
27. Do you develop a rash or hives when you exercise? YES NO
28. Were you born without or are you missing kidney, an eye, a testicle (males) or any YES NO
other organ?
29. Do you have groin pain or painful bulge or hernia in the groin area? YES NO
30. Have you ever had Dengue hemorrhagic fever infection? YES NO
31. Do you have any rashes, pressure sores or other skin problems? YES NO
32. Have you ever had a head injury or concussion? YES NO
33. Have you ever had a hit or blow to the head that caused confussion prolonged YES NO
headache or memory problem?
1 of 2 MCForm – 2
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A4
A. PERSONAL DATA:
Name: CAMANDERO CRISTIAN D.

(Last) (First) (M.I.)
Sex: MALE Learner Reference Number (LRN) 130280130009 Contact Number 0

Date of Birth:
(mm/dd/yyyy) December 24, 2008 Age: 15 MIDPAPAN 2, PIGCAWAYAN, COTABATO
Place of Birth:
School: PIGCAWAYAN NATIONAL HIGH SCHOOL Grade Level 9
Address of School: POBLACION 2, PIGCAWAYAN, COTABATO
Present Address: MIDPAPAN 2, PIGCAWAYAN, COTABATO
Parents: JOSE RUFO A. CAMANDERO ERMANITA L. DOBLE
Fathers Name Mother/Guardian
Address of Parents: MIDPAPAN 2, PIGCAWAYAN, COTABATO
B. Participation in the previous Palarong Pambansa. Yes ____ No _____ . If Yes, kindly fill up the table below
Year of Participation Sports Event Venue Remarks

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
C. Athlete's Participation in Local/International Competition (For the Current School Year)
Inclusive Dates Sports Event Athletic Meet Remarks
NOVEMBER 13-18, 2023 ARNIS INTRAMURALS 0
December 30, 1899 ARNIS MUNICIPAL MEET 0
ARNIS CITY/DIVISION MEET
ARNIS SRAA MEET
ARNIS 0
(Use separate sheet if necessary)

CAMANDERO, CRISTIAN D.
Athlete 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

Name and Signature of Regional
Meet Name and Signature of Coach Division Sports Officer
Sports Officer (RSO)
(DSO)
INTRAMURALS 0 0 0
MUNICIPAL MEET 0 0 0
CITY/DIVISION MEET 0 0
SRAA MEET 0 0
0 0 0
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: ______________

Revised as of September 26, 2019 Republic of the Philippines
SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
CERTIFICATE OF ATTENDANCE
Date:
This is to certify that CAMANDERO, CRISTIAN D. has

been enrolled for the:
current school year
current semester.
This certification is being issued to attest that the learner has attended classes up to this date.
0 RICKY S. FLORES, PI
Adviser School Head/Registrar
(Signature Over Printed Name) (Signature Over Printed Name)

SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
Athlete’s Name: CAMANDERO, CRISTIAN D. Date of Examination:

Birthdate: December 24, 2008
MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
JOSE RUFO A. CAMANDERO ERMANITA L. DOBLE CAMANDERO, CRISTIAN D.

Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
12/30/1899
PARENT'S CONSENT Date
I/We hereby willingly and voluntarily give consent to the participation of my/our son/daughter
CAMANDERO, CRISTIAN D. in ARNIS in all School Sports Meets
up to the Palarong Pambansa.
I/We have considered the benefits that my son or daughter will derive from his/her participation in
this activity provided that due care, diligence and necessary precautions will be observed to ensure his/her health
and safety.
Further, I/We authorize the personnel of Department of Education to collect, process, retain, and dispose
of personal information of the above-mentioned athlete in accordance with the Data Privacy Act of 2012.
JOSE RUFO A. CAMANDERO ERMANITA L. DOBLE

Signature of Father Over Printed Name Signature of Mother Over Printed Name
0 RICKY S. FLORES, PI
Remarks:
Note:
by the adviser and school head, in cases signature of parents are unavailable.

SOCCSKSARGEN
Region
COTABATO
Division
DENTAL HEALTH RECORD

A4
Name: CAMANDERO, CRISTIAN D.
Age: 15 Sex: MALE Birth Date: 12/24/2008
Event: ARNIS
Parent/Guardian: JOSE RUFO A. CAMANDERO ERMANITA L. DOBLE
CONDITION AND TREATMENT NEEDS

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT
SYMBOLS FOR MOUTH EXAMINATION SYMBOLS FOR ACCOMPLISHMENT

X - TOOTH INDICATED DU - DECUBITAL ULCER XT - EXTRACTED PERMANENT TOOTH
FOR EXTRACTION MAL - MALOCLUSSION xt - EXTRACTED TEMPORARY TOOTH
F - TOOTH INDICATED FLU - FLUOROSIS Am - AMALGAM FILLING
FOR FILLING Gn - NORMAL Com - COMPOSITE FILLING
HEAVY - TOOTH WITH TEMPORARY Gm - MODERATE GINGIVITIS
SHADE FILLING (1-2 QUADRANTS) ARTIFICIAL RESTORATION
RC - RECURRENT CARIES Gs - SEVERE GINGIVITIS JC - JACKET CROWN
RF - ROOT FRAGMENT (3-4 QUADRANTS) I - INLAY
M - MISSING TOOTH CMR - COMPLETE MOUTH REHAB OP - ORAL PROPHYLAXIS
(√) - SOUND ERUPTED PERMANENT ZOE - ZINC OXIDE UEGENOL FILLING
TOOTH TF - TEMPORARY FILLING
R - REFERRED TO PRIVATE DENTIST
UN - UNERUPTED TOOTH
District Meet Remarks/Findings:
0 WITH THIRD MOLAR: REFERRED FOR DENTAL TREATMENT:
DENTIST YES NO YES NO
(signature over printed name) QUALIFIED TO PARTICiPATE:
PRC: LICENSE: 0 PTR# 0 Date Examined: YES NO
Division Meet Remarks/Findings:
(signature over printed name) QUALIFIED TO PARTICIPATE:
(signature over printed name) QUALIFIED TO PARTCIPATE:
WITH THIRD MOLAR: REFERRED FOR DENTAL TREATMENT:
PRC: LICENSE: PTR# Date Examined: YES NO
HOME
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A5
A. PERSONAL DATA:
Name: CEDEÑO SEYAN PATRICK L.

Date of Birth:
(mm/dd/yyyy) May 20, 2011 Age: 12 CAPAYURAN, PIGCAWAYAN, COTABATO
Place of Birth:
Present Address: CAPAYURAN, PIGCAWAYAN, COTABATO
Parents: 0 ARO CEDEÑO
Address of Parents: SOUTH MANUANGAN, PIGCAWAYAN, COTABATO

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
ARNIS SRAA MEET
ARNIS 0

CEDEÑO, SEYAN PATRICK L.

(DSO)
INTRAMURALS 0 0 0
SRAA MEET 0 0
0 0 0
Screened by:
Date: ______________ Date: ______________ Date: ______________

SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
Date:
This is to certify that CEDEÑO, SEYAN PATRICK L. has

current school year
current semester.
JASMINE DUMALAOG RICKY S. FLORES, PI


SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
Athlete’s Name: CEDEÑO, SEYAN PATRICK L. Date of Examination:

Birthdate: May 20, 2011
MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
0 ARO CEDEÑO CEDEÑO, SEYAN PATRICK L.

Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
12/30/1899
CEDEÑO, SEYAN PATRICK L. in ARNIS in all School Sports Meets
and safety.
0 ARO CEDEÑO
JASMINE DUMALAOG RICKY S. FLORES, PI

Remarks:
Note:

SOCCSKSARGEN
Region
COTABATO
Division

A5
Name: CEDEÑO, SEYAN PATRICK L.
Event: ARNIS
Parent/Guardian: 0 ARO CEDEÑO

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT

HOME
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A6
A. PERSONAL DATA:
Name: ALMONARES III RICHARD F.


Date of Birth:
(mm/dd/yyyy) January 10, 2009 Age: 15 Place of Birth: MARIKINA CTY
Present Address: MIDPAPAN 2, PIGCAWAYAN, COTABATO
Parents: RICHARD E. ALMONARES JR. SHERYL D. FRANCISCO
Address of Parents: SOUTH MANUANGAN, PIGCAWAYAN, COTABATO

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
ARNIS SRAA MEET
ARNIS 0

ALMONARES III, RICHARD F.

(DSO)
INTRAMURALS 0 0 0
SRAA MEET 0 0
0 0 0
Screened by:
Date: ______________ Date: ______________ Date: ______________

SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
Date:
This is to certify that ALMONARES III, RICHARD F. has

current school year
current semester.
JOAN JOY S. SIBYA RICKY S. FLORES, PI


SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
Athlete’s Name: ALMONARES III, RICHARD F. Date of Examination:
Birthdate: January 10, 2009
MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
RICHARD E. ALMONARES JR. SHERYL D. FRANCISCO ALMONARES III, RICHARD F.

Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
School
School Address
12/30/1899
ALMONARES III, RICHARD F. in ARNIS in all School Sports Meets
and safety.
RICHARD E. ALMONARES JR. SHERYL D. FRANCISCO

JOAN JOY S. SIBYA RICKY S. FLORES, PI

Remarks:
Note:

SOCCSKSARGEN
Region
COTABATO
Division

Name: ALMONARES III, RICHARD F. A6
Event: ARNIS
Parent/Guardian: RICHARD E. ALMONARES JR. SHERYL D. FRANCISCO

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT


HOME
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A7
A. PERSONAL DATA:
Name: 0 0 0
Sex: 0 Learner Reference Number (LRN) 0 Contact Number 0

Date of Birth:
(mm/dd/yyyy) December 30, 1899 Age: 124 Place of Birth: 0
School: 0 Grade Level 0
Address of School: 0
Present Address: 0
Parents: 0 0
Address of Parents: 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
December 30, 1899 ARNIS INTRAMURALS 0
ARNIS SRAA MEET
ARNIS 0

0

(DSO)
INTRAMURALS 0 0 0
SRAA MEET 0 0
0 0 0
Screened by:
Date: ______________ Date: ______________ Date: ______________

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
Date:
This is to certify that 0 has

current school year
current semester.
0 0

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
Athlete’s Name: 0 Date of Examination:

MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
0 0 0
Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
12/30/1899
0 in 0 in all School Sports Meets
and safety.
0 0
0 0
Remarks:
Note:

SOCCSKSARGEN
Region
COTABATO
Division

Name: 0 A7
Age: 124 Sex: 0 Birth Date: 12/30/1899
Event: 0
Parent/Guardian: 0 0

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT


HOME
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A8
A. PERSONAL DATA:
Name: 0 0 0

Date of Birth:
Present Address: 0
Parents: 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
ARNIS SRAA MEET
ARNIS 0

0

(DSO)
INTRAMURALS 0 0 0
SRAA MEET 0 0
0 0 0
Screened by:
Date: ______________ Date: ______________ Date: ______________

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
Date:

current school year
current semester.
0 0

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address

MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
0 0 0
Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
12/30/1899
and safety.
0 0
0 0
Remarks:
Note:

SOCCSKSARGEN
Region
COTABATO
Division

A8
Name: 0
Event: 0

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT

HOME
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A9
A. PERSONAL DATA:
Name: 0 0 0

Date of Birth:
Present Address: 0
Parents: 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
ARNIS SRAA MEET
ARNIS 0

0

(DSO)
INTRAMURALS 0 0 0
SRAA MEET 0 0
0 0 0
Screened by:
Date: ______________ Date: ______________ Date: ______________

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
Date:

current school year
current semester.
0 0

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address

MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
0 0 0
Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
12/30/1899
and safety.
0 0
0 0
Remarks:
Note:

SOCCSKSARGEN
Region
COTABATO
Division

A9
Name: 0
Event: 0

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT

HOME
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A10
A. PERSONAL DATA:
Name: 0 0 0

Date of Birth:
Present Address: 0
Parents: 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
ARNIS SRAA MEET
ARNIS 0

0

(DSO)
INTRAMURALS 0 0 0
SRAA MEET 0 0
0 0 0
Screened by:
Date: ______________ Date: ______________ Date: ______________

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
Date:

current school year
current semester.
0 0

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address

MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
0 0 0
Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
12/30/1899
and safety.
0 0
0 0
Remarks:
Note:

SOCCSKSARGEN
Region
COTABATO
Division

A10
Name: 0
Event: 0

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT


HOME
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A11
A. PERSONAL DATA:
Name: 0 0 0

Date of Birth:
Present Address: 0
Parents: 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
ARNIS SRAA MEET
ARNIS 0

,

(DSO)
INTRAMURALS 0 0 0
SRAA MEET 0 0
0 0 0
Screened by:
Date: ______________ Date: ______________ Date: ______________

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
Date:
This is to certify that , has

current school year
current semester.
0 0

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
Athlete’s Name: , Date of Examination:

MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
0 0 ,
Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
12/30/1899
, in 0 in all School Sports Meets
and safety.
0 0
0 0
Remarks:
Note:

SOCCSKSARGEN
Region
COTABATO
Division

A11
Name: ,
Event: 0

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT

HOME
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A12
A. PERSONAL DATA:
Name: 0 0 0

Date of Birth:
Present Address: 0
Parents: 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
ARNIS SRAA MEET
ARNIS 0

,

(DSO)
INTRAMURALS 0 0 0
SRAA MEET 0 0
0 0 0
Screened by:
Date: ______________ Date: ______________ Date: ______________

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
Date:

current school year
current semester.
0 0

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address

MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
0 0 ,
Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
12/30/1899
and safety.
0 0
0 0
Remarks:
Note:

SOCCSKSARGEN
Region
COTABATO
Division

A12
Name: ,
Event: 0

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT

HOME
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A13
A. PERSONAL DATA:
Name: 0 0 0

Date of Birth:
Present Address: 0
Parents: 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
ARNIS SRAA MEET
ARNIS 0

,

(DSO)
INTRAMURALS 0 0 0
SRAA MEET 0 0
0 0 0
Screened by:
Date: ______________ Date: ______________ Date: ______________

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
Date:

current school year
current semester.
0 0

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
0 0 ,
Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
12/30/1899
and safety.
0 0
0 0
Remarks:
Note:

SOCCSKSARGEN
Region
COTABATO
Division

A13
Name: ,
Event: 0

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT


HOME
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A14
A. PERSONAL DATA:
Name: 0 0 0

Date of Birth:
Present Address: 0
Parents: 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
ARNIS SRAA MEET
ARNIS 0

,

(DSO)
INTRAMURALS 0 0 0
SRAA MEET 0 0
0 0 0
Screened by:
Date: ______________ Date: ______________ Date: ______________

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
Date:
This is to certify that CAMANDERO, CRISTIAN D. has

current school year
current semester.
0 0

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address

MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
0 0 ,
Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
12/30/1899
and safety.
0 0
0 0
Remarks:
Note:

SOCCSKSARGEN
Region
COTABATO
Division

Name: , A14
Event: 0

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT

HOME
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A15
A. PERSONAL DATA:
Name: 0 0 0

Place of B
Date of Birth: Indicate th
(mm/dd/yyyy) December 30, 1899 Age: 124 Place of Birth: 0 Municipal
School: 0 Grade Level 0 City
Present Address: 0
Parents: 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
ARNIS SRAA MEET
ARNIS 0

,

(DSO)
INTRAMURALS 0 0 0
SRAA MEET 0 0
0 0 0
Screened by:
Date: ______________ Date: ______________ Date: ______________

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
Date:

current school year
current semester.
0 0

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address

MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
0 0 ,
Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
12/30/1899
Place of Birth:
Indicate the
Municipality/Province/
City I/We have considered the benefits that my son or daughter will derive from his/her participation in
and safety.
0 0
0 0
Remarks:
Note:

SOCCSKSARGEN
Region
COTABATO
Division

Name: , A15
Event: 0

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT

HOME
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A16
A. PERSONAL DATA:
Name: 0 0 0

Date of Birth:
Present Address: 0
Parents: 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
ARNIS SRAA MEET
ARNIS 0

,

(DSO)
INTRAMURALS 0 0 0
SRAA MEET 0 0
0 0 0
Screened by:
Date: ______________ Date: ______________ Date: ______________

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
Date:

current school year
current semester.
0 0

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address

MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
0 0 ,
Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
12/30/1899
and safety.
0 0
0 0
Remarks:
Note:

SOCCSKSARGEN
Region
COTABATO
Division

A16
Name: ,
Event: 0

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT


HOME
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A17
A. PERSONAL DATA:
Name: 0 0 0

Date of Birth:
Present Address: 0
Parents: 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
ARNIS SRAA MEET
ARNIS 0

,

(DSO)
INTRAMURALS 0 0 0
SRAA MEET 0 0
0 0 0
Screened by:
Date: ______________ Date: ______________ Date: ______________

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
Date:

current school year
current semester.
0 0

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address

MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
0 0 ,
Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
12/30/1899
and safety.
0 0
0 0
Remarks:
Note:

SOCCSKSARGEN
Region
COTABATO
Division

A17
Name: ,
Event: 0

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT


HOME
AR(ATHLETE RECORD)
SOCCSKSARGEN
Region
COTABATO
Division
A18
A. PERSONAL DATA:
Name: 0 0 0

Date of Birth:
Present Address: 0
Parents: 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
ARNIS SRAA MEET
ARNIS 0

,

(DSO)
INTRAMURALS 0 0 0
SRAA MEET 0 0
0 0 0
Screened by:
Date: ______________ Date: ______________ Date: ______________

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
Date:

current school year
current semester.
0 0

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address

MEDICAL HISTORY

medicines or pills?
or after exercise?
other organ?
1 of 2 MCForm – 2

SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
YES NO REMARKS
or falling?
YES NO
FEMALES ONLY YES NO
NOTES:
0 0 ,
Date
2 of 2 MCForm – 2
SOCCSKSARGEN
Region
COTABATO
Division
0
School
0
School Address
12/30/1899
and safety.
0 0
0 0
Remarks:
Note:

SOCCSKSARGEN
Region
COTABATO
Division

A18
Name: ,
Event: 0

CONDITION
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT
TEMPORARY TEETH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
PERMANENT TEETH
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
CONDITION
TREATMENT NEEDS
TEMPORARY TEETH
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT
CONDITION
YEAR LEVEL REMARKS

DATE
EXAMINATION
SEALANT (GI)
PERMANENT FILLING
ART
EXTRACTION
ORAL PROPHYLAXIS
REFERRAL
OTHER ORAL
TREATMENT

HOME

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REPUBLIC OF THE PHILIPPINES

PLACE ALL ENTRIES

Note: FOR GYMNASTICS AND COMBATIVE SPORTS ONLY

IF DECEASED, SECURE DEATH CERTIFICATE.

To Whom It May Concern: To Whom It May Concer

This is to certify that CUSTADO, NIGEL T. has completed

To Whom It May Concern: To Whom It May Concer

This is to certify that MALANTAWAN, HAMSA J. has completed

To Whom It May Concern: To Whom It May Concer

This is to certify that MARCELINO, JONY A. has completed

To Whom It May Concern: To Whom It May Concern:

DEPARTMENT OF EDUCATION DEPART

To Whom It May Concern: To Whom It May Concern:

To Whom It May Concern: To Whom It May Concern:

CERTIFICATE OF COMPLETION CERTIFICATE O

m It May Concern: To Whom It May Concern:

This is to certify that 0 has completed This is to certify that

Grade/Year (Elementary/Secondary Level) for the School Yea . the Grade/Year

DEPARTMENT OF EDUCATION DEPARTMENT OF

CERTIFICATE OF COMPLETION CERTIFICATE O

m It May Concern: To Whom It May Concern:

This is to certify that 0 has completed This is to certify that

Grade/Year (Elementary/Secondary Level) for the School Yea . the Grade/Year

CERTIFICATE OF COMPLETION CERTIFICATE O

m It May Concern: To Whom It May Concern:

This is to certify that 0 has completed This is to certify that

Grade/Year (Elementary/Secondary Level) for the School Yea . the Grade/Year

CERTIFICATE OF COMPLETION CERTIFICATE OF COM

To Whom It May Concern:

0 has completed This is to certify that ,

(Elementary/Secondary Level) for the School Yea . the Grade/Year (Elementary/Secondary L

DEPARTMENT OF EDUCATION DEPARTMENT OF EDUCA

CERTIFICATE OF COMPLETION CERTIFICATE OF COM

To Whom It May Concern:

, has completed This is to certify that ,

(Elementary/Secondary Level) for the School Yea . the Grade/Year (Elementary/Secondary L

CERTIFICATE OF COMPLETION CERTIFICATE OF COM

To Whom It May Concern:

, has completed This is to certify that ,

(Elementary/Secondary Level) for the School Yea . the Grade/Year (Elementary/Secondary L

IFICATE OF COMPLETION CERTIFICATE OF COMPLETI

To Whom It May Concern:

, has completed This is to certify that ,

EPARTMENT OF EDUCATION DEPARTMENT OF EDUCATION

IFICATE OF COMPLETION CERTIFICATE OF COMPLETI

To Whom It May Concern:

, has completed This is to certify that ,

IFICATE OF COMPLETION CERTIFICATE OF COMPLETI

To Whom It May Concern:

, has completed This is to certify that ,

ntary/Secondary Level) for the School Yea .

ntary/Secondary Level) for the School Yea .

ntary/Secondary Level) for the School Yea .

Athletic Meet REMARKS Remarks-PARENTAL CONSENT (A1)

Remarks-PARENTAL CONSENT (A2)

Remarks-PARENTAL CONSENT (A3)

Remarks-PARENTAL CONSENT (A4)

Remarks-PARENTAL CONSENT (A5)

POBLACION 2, PIGCAWAYAN, COTABATO COTABATO 124 130273160004

ARENTAL CONSENT (A1) Remarks-PARENTAL CONSENT (A6)

ARENTAL CONSENT (A2) Remarks-PARENTAL CONSENT (A7)

ARENTAL CONSENT (A3) Remarks-PARENTAL CONSENT (A8)

ARENTAL CONSENT (A4) Remarks-PARENTAL CONSENT (A9)