Revised July 2019

AR-I (ATHLETE RECO

IV-A- CALABARZON
Region

LIPA CITY
Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: LAZO IVAN REEVE

(Last) (First)

Sex: M Learner Reference Number (LRN) 403215 150163

Date of Birth: (mm/dd/yyyy) 04-29-03 Age: 16 Place of Birth:

School: LIPA MONTESSORI SCHOOL OF LEARNING INC.

Address of School: TRANSVILLE HOMES BANAYBANAY , LIPA CITY
Present Address: BANAYBANAY LIPA CITY
Parents: RODEL C. LAZO IMELDA J. LAZO
Fathers Name Mother/Guardian
Address of Parents: BANAYBANAY LIPA CITY

B. Participation in the previous Palarong Pambansa. Yes ____ No _____ . If Yes, kindly fill up the table below
Year of Participation Sports Event Venue

C. Athlete's Participation in Local/International Competition (For the Current School Year)

Inclusive Dates Sports Event Athletic Meet
March - May 2019 Sotero Cup

(Use separate sheet if necessary)

 Athlete Signature over Printed Name

D. Certification on Athlete's Participation

This is to certify that based on our knowledge the above-mentioned athlete has participated in the lower meets.

Name and Signature of Division

Division/Regional Meet Name and Signature of Coach
Sports Officer (DSO)

(Use separate sheet if necessary)

Screened by:

Division Meet Regional Meet

(Signature of DSAC over Printed Name) (Signature of RSAC over Printed Name)

Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

AR-I (ATHLETE RECORD)

Latest 1½ x 1½ picture

REEVE J.
(M.I.)

Contact Number 9668000052

LIPA CITY

Grade Level Grade 11

IMELDA J. LAZO
Mother/Guardian

y fill up the table below

nue Remarks

ic Meet Remarks
 ature over Printed Name

icipated in the lower meets.

Name and Signature of Division Name and Signature of

Sports Officer (DSO) Regional Sports Officer (RSO)

Palarong Pambansa

(Signature of NSAC over Printed Name)

Date: ______________