AR-I (ATHLETE RECORD)

VI - WESTERN VISAYAS
Region

AKLAN
Division Latest 1½ x 1½ picture

D'SILVA, KENLEE M.

A. PERSONAL DATA:

Name: D'SILVA KENLEE M.

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

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

Date of Birth: (mm/dd/yy) 5/9/2008 Age: 10 Place of Birth: KALIBO, AKLAN

SERGIO L. TALIGATOS
School: ELEMENTARY SCHOOL BEIS (Private School Number )
PUDIOT, TANGALAN,
Address of School: AKLAN
Home Address: PUDIOT, TANGALAN, AKLAN
Parents: ANDREW D'SILVA ANNA M. D'SILVA
Fathers Name Mother/Guardian
Address of Parents: PUDIOT, TANGALAN, AKLAN

B. Athlete's Participation in Local/International Competition

Inclusive Dates Sports Event Athletic Meet Remarks
August 24 - 25, 2018 ATHLETICS-THROWING (BOYS) SCHOOL INTRAMURAL MEET CHAMPION

(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 Athletic Manager/Sports Coordinator
School Intramural Meet CHRISTINE T. PADERNAL ROCHELLE A. YARRA
District/Unit/Congrssional Meet
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: