AR-I (ATHLETE RECORD)

NCR
Region

QUEZON CITY
Division Latest 1½ x 1½ picture

A. PERSONAL DATA:

Name: CASUAT GABRIEL HAROLD U.

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

Sex: M Learner Reference Number (LRN) Contact Number:

Date of Birth: (mm/dd/yy) Age: 12 Place of Birth: CALOOCAN CITY
School: BEIS (Private School Number )
Address of School:
Home Address:
Parents: JIM HAROLD F. CASUAT RAQUEL U.CASUAT
Fathers Name Mother/Guardian
Address of Parents:

B. Athlete's Participation in Local/International Competition

Inclusive Dates Sports Event Athletic Meet Remarks

19-Oct-16 TAEKWONDO CLUSTER MEET GOLD MEDAL

(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
Division/Provincial Meet
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