Revised as of September 26, 2019 REGION 02- CAGAYAN VALLEY

REGION
CAUAYAN CITY
DIVISION

VOLLEYBALL GIRLS SECONDARY

EVENT

CACR (COACH / ASST. COACH RECORD

CERTIFICATE OF EMPLOYMENT
APPOINTMENT PUBLIC TEACHERS/ CONTRACT OF SERVICE/NOTARIZED
OMNIBUS AFFIDAVIT
Coach Coach
MEDICAL CERTIFICATE
CERTIFICATE OF TRAINING
CERTIFICATE OF SPORTS MEMBERSHIP
CERT. OF SPORTS RECOGNITION IN LOWER MEETS

TUPPIL, ZENARD ARJAY P. NAME DUAZO, RICHMON JAY D.

CCNHS- Main SCHOOL CCNHS- Main

APPOINTMENT/EMPLOYMENT/CONTRACT OF SERVICE
CERTIFICATE OF COMMITMENT
MEDICAL CERTIFICATE

Chaperon

NAME
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. DENTAL CERTIFICATE
H. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

ASUNCION, MICAH ELA T. NAME OF ATHLETE BURAGA, YSTAÑA YLYAAN C.

103228130464 LRN 400423150097
19-Jan-08 DATE OF BIRTH 18-Sep-09
CCNHS- Main SCHOOL CCNHS- Main

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. DENTAL CERTIFICATE
H. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

AGBAYANI, JONALYN A. NAME OF ATHLETE CARAG, JOANA MARIE O.

103228130051 LRN 103200160019
13-Mar-08 DATE OF BIRTH 21-Nov-10
CCNHS- Main SCHOOL CCNHS- Main

NOTE:
PLEASE USE A4 SIZE COPY PAPER
Revised as of September 26, 2019 REGION 02- CAGAYAN VALLEY
REGION
CAUAYAN CITY
DIVISION

VOLLEYBALL GIRLS 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. DENTAL CERTIFICATE
H. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

GANDEZA, SHAINE S. NAME OF ATHLETE PERALTA, REAH MAE A.

103200160023 LRN 103236120038
23-Oct-10 DATE OF BIRTH 17-Sep-06
CCNHS- Main SCHOOL CCNHS- Main

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. DENTAL CERTIFICATE
H. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

LOPEZ, ANGEL MAE B. NAME OF ATHLETE REYES, ROSEBEL P.

103222130033 LRN 103211120250
23-Nov-07 DATE OF BIRTH 2-Apr-07
CCNHS- Main SCHOOL CCNHS- Main

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. DENTAL CERTIFICATE
H. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

MAGAT, NIKKI G. NAME OF ATHLETE TAGUBA, MARY NICOLE G.

103211140239 LRN 103216160003
5-Oct-08 DATE OF BIRTH 8-Sep-11
CCNHS-Main SCHOOL CCNHS- Main

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. DENTAL CERTIFICATE
H. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

MENIA, ANGELICA JANE B. NAME OF ATHLETE TICSAY, NICOLE ASHLEE M.

103222130036 LRN 106097130118
9-Jan-08 DATE OF BIRTH 18-Apr-08
CCNHS- Main SCHOOL CCNHS- Main

NOTE:
PLEASE USE A4 SIZE COPY PAPER