2024 Athlete Record 1

Revised as of September 26, 2019
AR (ATHLETE RECORD)
CORDILLERA ADMINISTRATIVE REGION
Region
MOUNTAIN PROVINCE
Latest 1½ x 1½ picture
Division
A. PERSONAL DATA:
Name: BUSETAN DWAYNE RAYE E.

(Last) (First) (M.I.)
Sex: MALE Learner Reference Number (LRN) 136381110026 Contact Number 0946-638-2737
Date of Birth: (mm/dd/yyyy) 1/21/2006 Age: 18 Place of Birth: La Trinidad, Benguet

School: GUINZADAN NATIONAL HIGH SCHOOL Grade Level 12
Address of School: GUINZADAN CENTRAL, BAUKO, MOUNTAIN PROVINCE
Present Address: CENTRAL PAMUNGYAN, LAGAWA, BAUKO, MOUNTAIN PROVINCE
Parents: CLAUDIO JR B. BUSETAN ANNALYN E. BUSETAN
Fathers Name Mother/Guardian
Address of Parents/Guardian: LAGAWA, BAUKO, MOUNTAIN PROVINCE
B. Participation in the previous Palarong Pambansa. Yes ____ No __√___ . If Yes, kindly fill up the table below
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
DECEMBER 8-9, 2023 BASKETBALL - SECONDARY DISTRICT MEET GOLD
(Use separate sheet if necessary)
DWAYNE RAYE E. BUSETAN

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 been a member of a school based club and 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)
DISTRICT MEET CHESTER B. CULLA-AG

MARGIE A. LIGLIGEN
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)

AR (ATHLETE RECORD)
Region
MOUNTAIN PROVINCE
Division
A. PERSONAL DATA:
Name: BUGTONG EINER JHONIDEL C.

Date of Birth: (mm/dd/yyyy) 01/11/2007 Age: 17 Place of Birth: BAUKO, MOUNTAIN PROVINCE
Present Address: BANAO, BAUKO, MOUNTAIN PROVINCE
Parents: RENIE D. BUGTONG MARJORIE C. BUGTONG
Address of Parents/Guardian: BANAO, BAUKO, MOUNTAIN PROVINCE
EINER JHONIDEL C. BUGTONG




MARGIE A. LIGLIGEN
Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
Region
MOUNTAIN PROVINCE
Division
A. PERSONAL DATA:
Name: CADWISING ZACKARY TROY B.

Present Address: GUINZADAN SUR, BAUKO, MOUNTAIN PROVINCE
Parents: LIONEIL CHRIS D. CADWISING MILDRED B. CADWISING
Address of Parents/Guardian: GUINZADAN SUR, BAUKO, MOUNTAIN PROVINCE
ZACKARY TROY B. CADWISING




MARGIE A. LIGLIGEN
Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
Region
MOUNTAIN PROVINCE
Division
A. PERSONAL DATA:
Name: CARPIO RANIEL KENT P.

Date of Birth: (mm/dd/yyyy) 12/23/2007 Age: 16 Place of Birth: MAPANDAN, PANGASINAN

Present Address: GUINZADAN CENTRAL, BAUKO, MOUNTAIN PROVINCE
Parents: RENEL R. CARPIO ROSARIO B. PALANGDOSAN
Address of Parents/Guardian: GUINZADAN CENTRAL, BAUKO, MOUNTAIN PROVINCE
RANIEL KENT P. CARPIO




MARGIE A. LIGLIGEN
Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
Region
MOUNTAIN PROVINCE
Division
A. PERSONAL DATA:
Name: CATIYAN DIXON B.

Present Address: GUINZADAN SUR, BAUKO, MOUNTAIN PROVINCE
Parents: RAMON CATIYAN VICENTA CATIYAN
Address of Parents/Guardian: GUINZADAN SUR, BAUKO, MOUNTAIN PROVINCE
DIXON B. CATIYAN



MARGIE A. LIGLIGEN
Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
Region
MOUNTAIN PROVINCE
Division
A. PERSONAL DATA:
Name: DEL ROSARIO SALVI JAY A.

Sex: MALE Learner Reference Number (LRN) 136204130013 Contact Number NONE
Present Address: BILA, BAUKO, MOUNTAIN PROVINCE
Parents: MALVIN DEL ROSARIO ROSALYN DEL ROSARIO
Address of Parents/Guardian: BILA, BAUKO, MOUNTAIN PROVINCE
SALVI JAY A. DEL ROSARIO




MARGIE A. LIGLIGEN
Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
Region
MOUNTAIN PROVINCE
Division
A. PERSONAL DATA:
Name: MATEO JEDIDIA

Sex: MALE Learner Reference Number (LRN) 136211110037 Contact Number NONE
Parents: ROMA M. BANAKEN
JEDIDIA MATEO



MARGIE A. LIGLIGEN
Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
Region
MOUNTAIN PROVINCE
Division
A. PERSONAL DATA:
Name: PALANGDOSAN ASPREL II M.

Present Address: BANAO, BAUKO, MOUNTAIN PROVINCE
Parents: ASPREL L. PALANGDOSAN MARIA M. PALANGDOSAN
Address of Parents/Guardian: BANAO, BAUKO, MOUNTAIN PROVINCE
ASPREL II M. PALANGDOSAN



MARGIE A. LIGLIGEN
Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
Region
MOUNTAIN PROVINCE
Division
A. PERSONAL DATA:
Name: PUDSOC PATRICK M.

Sex: MALE Learner Reference Number (LRN) 136211120027 Contact Number N/A
Parents: JOSEPH PUDSOC ZENAIDA PUDSOC
PATRICK M. PUDSOC



MARGIE A. LIGLIGEN
Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
Region
MOUNTAIN PROVINCE
Division
A. PERSONAL DATA:
Name: SONGAG DAVE D.

Date of Birth: (mm/dd/yyyy) 03/18/2006 Age: 17 Place of Birth: TADIAN, MOUNTAIN PROVINCE
Present Address: BALAOA, TADIAN, MOUNTAIN PROVINCE
Parents: JONIFER SONGAG IRENE SONGAG
Address of Parents/Guardian: BALAOA, TADIAN, MOUNTAIN PROVINCE
DAVE D. SONGAG



MARGIE A. LIGLIGEN
Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
Region
MOUNTAIN PROVINCE
Division
A. PERSONAL DATA:
Name: TONG-A-AN GLESON G.

Parents: GLEN TONG-A-AN HENELYN TONG-A-AN
GLESON G. TONG-A-AN



MARGIE A. LIGLIGEN
Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
Region
MOUNTAIN PROVINCE
Division
A. PERSONAL DATA:
Name: ZAPARITA ARIES A.

Parents: AGUSTO F. ZAPARITA ELENA A. ZAPARITA
ARIES A. ZAPARITA



MARGIE A. LIGLIGEN
Screened by:
Date: ______________ Date: ______________ Date: ______________

2024 Athlete Record 1

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2024 Athlete Record 1

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Revised as of September 26, 2019

Name: BUSETAN DWAYNE RAYE E.

Date of Birth: (mm/dd/yyyy) 1/21/2006 Age: 18 Place of Birth: La Trinidad, Benguet

(Use separate sheet if necessary)

DWAYNE RAYE E. BUSETAN

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

DISTRICT MEET CHESTER B. CULLA-AG

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: BUGTONG EINER JHONIDEL C.

(Use separate sheet if necessary)

EINER JHONIDEL C. BUGTONG

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

DISTRICT MEET CHESTER B. CULLA-AG

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: CADWISING ZACKARY TROY B.

(Use separate sheet if necessary)

ZACKARY TROY B. CADWISING

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

DISTRICT MEET CHESTER B. CULLA-AG

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: CARPIO RANIEL KENT P.

Date of Birth: (mm/dd/yyyy) 12/23/2007 Age: 16 Place of Birth: MAPANDAN, PANGASINAN

(Use separate sheet if necessary)

RANIEL KENT P. CARPIO

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

DISTRICT MEET CHESTER B. CULLA-AG

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: CATIYAN DIXON B.

(Use separate sheet if necessary)

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

DISTRICT MEET CHESTER B. CULLA-AG

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: DEL ROSARIO SALVI JAY A.

(Use separate sheet if necessary)

SALVI JAY A. DEL ROSARIO

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

DISTRICT MEET CHESTER B. CULLA-AG

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: MATEO JEDIDIA

(Use separate sheet if necessary)

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __