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AR-I (ATHLETE RECORD)

I
Region

ILOCOS NORTE
Division Latest 1 x 1 picture

A. PERSONAL DATA:

Name: TALON, ASTRID G.


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

Sex: MALE Learner Reference Number (LRN) 100138110024 Contact Number:


Date of Birth: (mm/dd/yy) NOVEMBER 19, 200-5- Age: 12 Place of Birth: DINGRAS, ILOCOS NORTE
School: SUYO ELEMENTARY SCHOOL BEIS (Private School Number )
Address of School: BRGY. SUYO, DINGRAS, ILOCOS NORTE
Home Address: BRGY. SUYO, DINGRAS, ILOCOS NORTE
Parents: BERNARDO G. TALON JR. MELINDA G. GABUYO
Fathers Name Mother/Guardian
Address of Parents: BRGY. SUYO, DINGRAS, ILOCOS NORTE

B. Athlete's Participation in Local/International Competition


Inclusive Dates Sports Event Athletic Meet Remarks
SEPTEMBER 29, 2017 TABLE TENNIS BOYS ELEMENTARY DISTRICT MEET/UNIT MEET CHAMPION
OCTOBER 27-29, 2016 TABLE TENNIS BOYS ELEMENTARY DIVISION/ PROVINCIAL MEET CHAMPION
MARCH 3-8, 2017 TABLE TENNIS BOYS ELEMENTARY REGIONAL MEET
PALARONG PAMBANSA
OTHERS

(Use separate sheet if necessary)

Athlete's Signature

C. Athlete's Participation
This is to certify that based on our knowledge the above-mentioned athlete has participated
in the lower meets.
Athletic meet Name of Coach Signature Division PESS Supervisor/s
District/Unit/Congrssional Meet MARIE JOY F. SARMIENTO
Division/Provincial Meet MARIE JOY F. SARMIENTO
Regional Meet
Palarong Pambansa

(Use separate sheet if necessary)

Screened by:

Division Meet Regional Meet

(Signature over Printed Name) (Signature over Printed Name)

Date: Date:
FOR PALARONG PAMBANSA ONLY
AR-I (ATHLETE RECORD)
I
Region

ILOCOS NORTE
Division Latest 1 x 1 picture

A. PERSONAL DATA:

Name: FERNANDO, KARL LAWRENZ N.


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

Sex: MALE Learner Reference Number (LRN) 100129120004 Contact Number:


Date of Birth: (mm/dd/yy) NOVEMBER 11, 2006 Age: 10 Place of Birth: DINGRAS, ILOCOS NORTE
School: SUYO ELEMENTARY SCHOOL BEIS (Private School Number )
Address of School: BRGY. SUYO, DINGRAS, ILOCOS NORTE
Home Address: BRGY. SUYO, DINGRAS, ILOCOS NORTE
Parents: ROLAND C. FERNANDO ZUERTE N. FERNANDO
Fathers Name Mother/Guardian
Address of Parents: BRGY. SUYO, DINGRAS, ILOCOS NORTE

B. Athlete's Participation in Local/International Competition


Inclusive Dates Sports Event Athletic Meet Remarks
0CTOBER 6-8, 2016 TABLE TENNIS BOYS ELEMENTARY DISTRICT MEET/UNIT MEET CHAMPION
OCTOBER 27-29, 2016 TABLE TENNIS BOYS ELEMENTARY DIVISION/ PROVINCIAL MEET CHAMPION
MARCH 3-8, 2017 TABLE TENNIS BOYS ELEMENTARY REGIONAL MEET
PALARONG PAMBANSA
OTHERS

(Use separate sheet if necessary)

Athlete's Signature

C. Athlete's Participation
This is to certify that based on our knowledge the above-mentioned athlete has participated
in the lower meets.
Athletic meet Name of Coach Signature Division PESS Supervisor/s
District/Unit/Congrssional Meet ADRIAN RYAN B. SARMIENTO GENE A. REGINALDO
Division/Provincial Meet ADRIAN RYAN B. SARMIENTO GENE A. REGINALDO
Regional Meet ADRIAN RYAN B. SARMIENTO GENE A. REGINALDO
Palarong Pambansa

(Use separate sheet if necessary)

Screened by:

Division Meet Regional Meet

(Signature over Printed Name) (Signature over Printed Name)

Date: Date:
FOR PALARONG PAMBANSA ONLY
AR-I (ATHLETE RECORD)
I
Region

ILOCOS NORTE
Division Latest 1 x 1 picture

A. PERSONAL DATA:

Name: SAHAGUN, SHERWIN S.


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

Sex: MALE Learner Reference Number (LRN) 100138120012 Contact Number:


Date of Birth: (mm/dd/yy) DECEMBER 15, 2006 Age: 10 Place of Birth: DINGRAS, ILOCOS NORTE
School: SUYO ELEMENTARY SCHOOL BEIS (Private School Number )
Address of School: BRGY. SUYO, DINGRAS, ILOCOS NORTE
Home Address: BRGY. SUYO, DINGRAS, ILOCOS NORTE
Parents: ARIEL M. SAHAGUN SHERELL S. SAHAGUN
Fathers Name Mother/Guardian
Address of Parents: BRGY. SUYO, DINGRAS, ILOCOS NORTE

B. Athlete's Participation in Local/International Competition


Inclusive Dates Sports Event Athletic Meet Remarks
0CTOBER 6-8, 2016 TABLE TENNIS BOYS ELEMENTARY DISTRICT MEET/UNIT MEET CHAMPION
OCTOBER 27-29, 2016 TABLE TENNIS BOYS ELEMENTARY DIVISION/ PROVINCIAL MEET CHAMPION
MARCH 3-8, 2017 TABLE TENNIS BOYS ELEMENTARY REGIONAL MEET
PALARONG PAMBANSA
OTHERS

(Use separate sheet if necessary)

Athlete's Signature

C. Athlete's Participation
This is to certify that based on our knowledge the above-mentioned athlete has participated
in the lower meets.
Athletic meet Name of Coach Signature Division PESS Supervisor/s
District/Unit/Congrssional Meet ADRIAN RYAN B. SARMIENTO GENE A. REGINALDO
Division/Provincial Meet ADRIAN RYAN B. SARMIENTO GENE A. REGINALDO
Regional Meet ADRIAN RYAN B. SARMIENTO GENE A. REGINALDO
Palarong Pambansa

(Use separate sheet if necessary)

Screened by:

Division Meet Regional Meet

(Signature over Printed Name) (Signature over Printed Name)

Date: Date:
FOR PALARONG PAMBANSA ONLY
AR-I (ATHLETE RECORD)
I
Region

ILOCOS NORTE
Division Latest 1 x 1 picture

A. PERSONAL DATA:

Name: TOLENTINO, EDRIAN M.


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

Sex: MALE Learner Reference Number (LRN) 100138100028 Contact Number:


Date of Birth: (mm/dd/yy) FEBRUARY 13, 2004 Age: 12 Place of Birth: DINGRAS, ILOCOS NORTE
School: SUYO ELEMENTARY SCHOOL BEIS (Private School Number )
Address of School: BRGY. SUYO, DINGRAS, ILOCOS NORTE
Home Address: BRGY. SUYO, DINGRAS, ILOCOS NORTE
Parents: LEOPOLDO T. TOLENTINO MYRNA M. TOLENTINO
Fathers Name Mother/Guardian
Address of Parents: BRGY. SUYO, DINGRAS, ILOCOS NORTE

B. Athlete's Participation in Local/International Competition


Inclusive Dates Sports Event Athletic Meet Remarks
0CTOBER 6-8, 2016 TABLE TENNIS BOYS ELEMENTARY DISTRICT MEET/UNIT MEET CHAMPION
OCTOBER 27-29, 2016 TABLE TENNIS BOYS ELEMENTARY DIVISION/ PROVINCIAL MEET CHAMPION
MARCH 3-8, 2017 TABLE TENNIS BOYS ELEMENTARY REGIONAL MEET
PALARONG PAMBANSA
OTHERS

(Use separate sheet if necessary)

Athlete's Signature

C. Athlete's Participation
This is to certify that based on our knowledge the above-mentioned athlete has participated
in the lower meets.
Athletic meet Name of Coach Signature Division PESS Supervisor/s
District/Unit/Congrssional Meet ADRIAN RYAN B. SARMIENTO GENE A. REGINALDO
Division/Provincial Meet ADRIAN RYAN B. SARMIENTO GENE A. REGINALDO
Regional Meet ADRIAN RYAN B. SARMIENTO GENE A. REGINALDO
Palarong Pambansa

(Use separate sheet if necessary)

Screened by:

Division Meet Regional Meet

(Signature over Printed Name) (Signature over Printed Name)

Date: Date:
FOR PALARONG PAMBANSA ONLY
AR-I (ATHLETE RECORD)
I
Region

ILOCOS NORTE
Division Latest 1 x 1 picture

A. PERSONAL DATA:

Name: HIDALGO, JASMINE ELEONORE N.


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

Sex: FEMALE Learner Reference Number (LRN) 100138110017 Contact Number:


Date of Birth: (mm/dd/yy) JUNE 04, 2006 Age: 10 Place of Birth: DINGRAS, ILOCOS NORTE
School: SUYO ELEMENTARY SCHOOL BEIS (Private School Number )
Address of School: BRGY. SUYO, DINGRAS, ILOCOS NORTE
Home Address: BRGY. SUYO, DINGRAS, ILOCOS NORTE
Parents: JEY-EL G. HIDALGO JULIET E. NICOLAS
Fathers Name Mother/Guardian
Address of Parents: BRGY. SUYO, DINGRAS, ILOCOS NORTE

B. Athlete's Participation in Local/International Competition


Inclusive Dates Sports Event Athletic Meet Remarks
0CTOBER 6-8, 2016 TABLE TENNIS GIRLS ELEMENTARY DISTRICT MEET/UNIT MEET CHAMPION
OCTOBER 27-29, 2016 TABLE TENNIS GIRLS ELEMENTARY DIVISION/ PROVINCIAL MEET CHAMPION
MARCH 3-8, 2017 TABLE TENNIS BOYS ELEMENTARY REGIONAL MEET
PALARONG PAMBANSA
OTHERS

(Use separate sheet if necessary)

Athlete's Signature

C. Athlete's Participation
This is to certify that based on our knowledge the above-mentioned athlete has participated
in the lower meets.
Athletic meet Name of Coach Signature Division PESS Supervisor/s
District/Unit/Congrssional Meet MARIE JOY F. SARMIENTO GENE A. REGINALDO
Division/Provincial Meet MARIE JOY F. SARMIENTO GENE A. REGINALDO
Regional Meet RENATO D. REYNO GENE A. REGINALDO
Palarong Pambansa

(Use separate sheet if necessary)

Screened by:

Division Meet Regional Meet

(Signature over Printed Name) (Signature over Printed Name)

Date: Date:
FOR PALARONG PAMBANSA ONLY
AR-I (ATHLETE RECORD)
I
Region

ILOCOS NORTE
Division Latest 1 x 1 picture

A. PERSONAL DATA:

Name: SARMIENTO, MARIAN BEAU SHAMIR F.


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

Sex: FEMALE Learner Reference Number (LRN) 100138130001 Contact Number:


Date of Birth: (mm/dd/yy) NOVEMBER 29, 2006 Age: 10 Place of Birth: DINGRAS, ILOCOS NORTE
School: SUYO ELEMENTARY SCHOOL BEIS (Private School Number )
Address of School: BRGY. SUYO, DINGRAS, ILOCOS NORTE
Home Address: BRGY. SUYO, DINGRAS, ILOCOS NORTE
Parents: ADRIAN RYAN B. SARMIENTO MARIE JOY F. SARMIENTO
Fathers Name Mother/Guardian
Address of Parents: BRGY. SUYO, DINGRAS, ILOCOS NORTE

B. Athlete's Participation in Local/International Competition


Inclusive Dates Sports Event Athletic Meet Remarks
0CTOBER 6-8, 2016 TABLE TENNIS GIRLS ELEMENTARY DISTRICT MEET/UNIT MEET CHAMPION
OCTOBER 27-29, 2016 TABLE TENNIS GIRLS ELEMENTARY DIVISION/ PROVINCIAL MEET CHAMPION
MARCH 3-8, 2017 TABLE TENNIS BOYS ELEMENTARY REGIONAL MEET
PALARONG PAMBANSA
OTHERS

(Use separate sheet if necessary)

Athlete's Signature

C. Athlete's Participation
This is to certify that based on our knowledge the above-mentioned athlete has participated
in the lower meets.
Athletic meet Name of Coach Signature Division PESS Supervisor/s
District/Unit/Congrssional Meet MARIE JOY F. SARMIENTO GENE A. REGINALDO
Division/Provincial Meet MARIE JOY F. SARMIENTO GENE A. REGINALDO
Regional Meet RENATO D. REYNO GENE A. REGINALDO
Palarong Pambansa

(Use separate sheet if necessary)

Screened by:

Division Meet Regional Meet

(Signature over Printed Name) (Signature over Printed Name)

Date: Date:
FOR PALARONG PAMBANSA ONLY
AR-I (ATHLETE RECORD)
I
Region

ILOCOS NORTE
Division Latest 1 x 1 picture

A. PERSONAL DATA:

Name: SARMIENTO, MARIAN BEAU SHAMIR F.


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

Sex: FEMALE Learner Reference Number (LRN) 100138130001 Contact Number:


Date of Birth: (mm/dd/yy) NOVEMBER 29, 2006 Age: 10 Place of Birth: DINGRAS, ILOCOS NORTE
School: SUYO ELEMENTARY SCHOOL BEIS (Private School Number )
Address of School: BRGY. SUYO, DINGRAS, ILOCOS NORTE
Home Address: BRGY. SUYO, DINGRAS, ILOCOS NORTE
Parents: ADRIAN RYAN B. SARMIENTO MARIE JOY F. SARMIENTO
Fathers Name Mother/Guardian
Address of Parents: BRGY. SUYO, DINGRAS, ILOCOS NORTE

B. Athlete's Participation in Local/International Competition


Inclusive Dates Sports Event Athletic Meet Remarks
0CTOBER 6-8, 2016 TABLE TENNIS GIRLS ELEMENTARY DISTRICT MEET/UNIT MEET CHAMPION
OCTOBER 27-29, 2016 TABLE TENNIS GIRLS ELEMENTARY DIVISION/ PROVINCIAL MEET CHAMPION
MARCH 3-8, 2017 TABLE TENNIS BOYS ELEMENTARY REGIONAL MEET
PALARONG PAMBANSA
OTHERS

(Use separate sheet if necessary)

Athlete's Signature

C. Athlete's Participation
This is to certify that based on our knowledge the above-mentioned athlete has participated
in the lower meets.
Athletic meet Name of Coach Signature Division PESS Supervisor/s
District/Unit/Congrssional Meet MARIE JOY F. SARMIENTO GENE A. REGINALDO
Division/Provincial Meet MARIE JOY F. SARMIENTO GENE A. REGINALDO
Regional Meet RENATO D. REYNO GENE A. REGINALDO
Palarong Pambansa

(Use separate sheet if necessary)

Screened by:

Division Meet Regional Meet

(Signature over Printed Name) (Signature over Printed Name)

Date: Date:
FOR PALARONG PAMBANSA ONLY

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