BRepublic of the Philippines

DEPARMENT OF EDUCATION
National Capital Region
DIVISION OF MAKATI

Division Palaro 2017

SCREENING FORM

DELEGATION: MAKATI I EVENT: VOLLEYBALL BOYS (SECONDARY)

Name of Athletes Age Date NSO Parental Dental Medical Form Gallery Remarks
Birth Consent Cert. 137/138 (Deficiencies)
1. Batayola, Elmer B. 16 March
21,2001

2. Bulan, Eric R. 17 Aug.

24,2000

4. Gonsalez, Joseph II A. 17 July

11,2000

5. Dabu, Stephen Hubert 14 Aug.

Ellezar 06,2003

6. Dela Carcel, Emil James C. 16 April

03,2001
7. Garcia, John Michael F. 17 July 16
2000
8. Jacinto, Rafael Gierom O. 15 Novemb
er 10,
2001
9. Legaspi, John Joshua T. 16 July 31
2001

10. Abat, Alberto Rey 14 Aug.

08,2003

11. Montano, Danny P. 16 Sept. 20

2001

12. Silagan, Melven J. 13 Sept.6

2004

13. Tapalgo, Shem Ansarri 14

14. Tuazon, Joseph P. 17 June 30

2000

15. Villanueva, Matthew 16 Jan.19

Azriel Joshua V. 2001

Screened by: ` Attested by:

___________________________________ _______________________________
School-based Screening Committee Head Coach
Date: _______________________