Region: Ar (Athlete Record)

Revised as of September 26, 2019
AR (ATHLETE RECORD)
VIII
Region
BORONGAN CITY
Latest 1½ x 1½ picture
Division
A. PERSONAL DATA:
Name: ABENIS MADELYN F.

(Last) (First) (M.I.)
Sex: FEMALE Learner Reference Number (LRN) 12235809003 Contact Number
Date of Birth: (mm/dd/yyyy) 18-Jan-03 Age: 16 Place of Birth: CALINGATNGAN BORONGAN CITY
School: CALINGATNGAN NATIONAL HIGH SCHOOL Grade Level GRADE 10
Address of School: BRGY. CALINGATNGAN BORONGAN CITY, EASTERN SAMAR
Present Address: SITIO LIPGUTAN BGRY. BALUID 2 BORONGAN CITY EASTERN SAMAR
Parents: PABLO C. ABENIS CARMENIA F. ABENIS
Fathers Name Mother/Guardian
Address of Parents/Guardian: SITIO LIPGUTAN BGRY. BALUID 2 BORONGAN CITY EASTERN SAMAR
B. Participation in the previous Palarong Pambansa. Yes ____ No _____ . If Yes, kindly fill up the table below
Year of Participation Sports Event Venue Remarks
C. Athlete's Participation in the Lower Meets (For the Current School Year)
Inclusive Dates Sports Event Athletic Meet Remarks
AUGUST 21,22,23,2019 TAEKWONDO INTRAMURAL MEET GOLD
OCTOBER 1 -2, 2019 TAEKWONDO DISTRICT MEET GOLD
(Use separate sheet if necessary)
ABENIS, MADELYN F.
Athlete's 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 Name and Signature of

Meet Name and Signature of Coach
Sports Officer (DSO) Regional Sports Officer (RSO)
INTRAMURAL MEET MA. NELLY C. TABUENA

DISTRICT MEET MA. NELLY C. TABUENA
Screened by:
Division Meet Regional Meet Palarong Pambansa
(Signature of DSAC over Printed Name) (Signature of RSAC over Printed Name) (Signature of NSAC over Printed Name)
Date: ______________ Date: ______________ Date: ______________
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

AR (ATHLETE RECORD)
VIII
Region
Borongan City
Division
A. PERSONAL DATA:
Name: BALEÑA MILDRED D.

Sex: FEMALE Learner Reference Number (LRN) 122371110003 Contact Number
Date of Birth: (mm/dd/yyyy) 3-Apr-06 Age: 13 Place of Birth: BORONGAN CITY

School: CALINGATNGAN NATIONAL HIGH SCHOOL Grade Level SEVEN
Address of School: BARANGAY CALINGATNGAN BORONGAN CITY EASTERN SAMAR
Present Address: SITIO LIPGUTAN BRGY. BALUD 2 BORONGAN CITY EASTERN SAMAR
Parents: CRISANTO BALEÑA LEONOR D. BALEÑA
Address of Parents/Guardian:
MILDRED D. BALEÑA


INTRAMURAL MEET MA. NELLY C. TABUENA

DISTRICT MEET MA. NELLY C. TABUENA
Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
VIII
Region
BORONGAN CITY
Division
A. PERSONAL DATA:
Name: PADUA JHARED RICA C.

Sex: FEMALE Learner Reference Number (LRN) 122361150166 Contact Number 9277386174
Date of Birth: (mm/dd/yyyy) 3-Jan-09 Age: 10 Place of Birth: BORONGAN CITY

School: EUGENIO S. DAZA PILOT ELEMENTARY SCHOOL Grade Level FIVE (5)
Address of School: BARANGAY G. BORONGAN CITY, EASTERN SAMAR
Present Address: SITIO LIPGUTAN BRGY. BALUD 2 BORONGAN CITY, EASTERN SAMAR
Parents: RICKY M. PADUA MERCY C. PADUA
Address of Parents/Guardian: SITIO LIPGUTAN BRGY. BALUD 2 BORONGAN CITY, EASTERN SAMAR
OCTOBER 18-19,2019 TAEKWONDO DISTRICT MEET GOLD
JHARED RICA C. PADUA



DISTRICT MEET ROSEMARIE O. BASILIA
Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
VIII
Region
BORONGAN CITY
Division
A. PERSONAL DATA:
Name: CARDONA GILBERT P.

Sex: MALE Learner Reference Number (LRN) 122358090021 Contact Number 9756035661
Date of Birth: (mm/dd/yyyy) 6-Jun-02 Age: 17 Place of Birth: BORONGAN CITY

School: CALINGATNGAN NATIONAL HIGH SCHOOL Grade Level TEN
Address of School: BARANGAY CALINGATNGAN BORONGAN CITY, EASTERN SAMAR
Present Address: BARANGAY CALINGATNGAN BORONGAN CITY, EASTERN SAMAR
Parents: LEO CARDONA YOLANDA P. CARDONA
Address of Parents/Guardian: BARANGAY CALINGATNGAN BORONGAN CITY, EASTERN SAMAR
CARDONA, GILBERT P.


INTRAMURAL MEET JOSEFINA C. ARMA

DISTRICT MEET JOSEFINA C. ARMA
Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
VIII
Region
BORONGAN CITY
Division
A. PERSONAL DATA:
Name: PORTILES JOHN REY G.

Sex: MALE Learner Reference Number (LRN) 122358120057 Contact Number
Date of Birth: (mm/dd/yyyy) 14-Jun-07 Age: 12 Place of Birth: BORONGAN CITY

School: CALINGATNGAN NATIONAL HIGH SCHOOL Grade Level SEVEN
Address of School: BARANGAY CALINGATNGAN BORONGAN CITY, EASTERN SAMAR
Present Address: BARANGAY CALINGATNGAN BORONGAN CITY, EASTERN SAMAR
Parents: REY PORTILES JR. JUDITH G.PORTILES
Address of Parents/Guardian: BARANGAY CALINGATNGAN BORONGAN CITY, EASTERN SAMAR
PORTILES, JOHN REY G.



INTRAMURAL MEET JOSEFINA C. ARMA

DISTRICT MEET JOSEFINA C. ARMA
Screened by:
Date: ______________ Date: ______________ Date: ______________

AR (ATHLETE RECORD)
VIII
Region
BORONGAN CITY
Division
A. PERSONAL DATA:
Name: PADUA TRICIA LAINE C.

Sex: FEMALE Learner Reference Number (LRN) 122361070274 Contact Number 9477540073
Date of Birth: (mm/dd/yyyy) DECEMBER 20,2002 Age: 16 Place of Birth: BORONGAN CITY
School: EASTERN SAMAR NATIONAL COMPREHENSIVE HIGH SCHOOL Grade Level 12
Address of School: BRGY. ALANG-ALANG BORONGAN CITY, EASTERN SAMAR
Present Address: SITIO LIPGUTAN BRGY. BALUD 2 BORONGAN CITY, EASTERN SAMAR
Parents: RICKY M. PADUA MERCY CASPE- PADUA
Address of Parents/Guardian: SITIO LIPGUTAN BRGY. BALUD 2 BORONGAN CITY, EASTERN SAMAR
2018 TAEKWONDO DAVAO CITY
SEPT. 25-27,2019 TAEKWONDO INTRAMURAL MEET GOLD
OCT.10-11,2019 TAEKWONDO DISTRICT MEET GOLD
PADUA, TRICIA LAINE C.



ESNCHS INTRAMURALS CLARIZA D. BALDAGO

DISTRICT MEET CLARIZA D. BALDAGO
Screened by:
Date: ______________ Date: ______________ Date: ______________

Region: Ar (Athlete Record)

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Region: Ar (Athlete Record)

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Revised as of September 26, 2019

Name: ABENIS MADELYN F.

Sex: FEMALE Learner Reference Number (LRN) 12235809003 Contact Number

(Use separate sheet if necessary)

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

INTRAMURAL MEET MA. NELLY C. TABUENA

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: BALEÑA MILDRED D.

Sex: FEMALE Learner Reference Number (LRN) 122371110003 Contact Number

Date of Birth: (mm/dd/yyyy) 3-Apr-06 Age: 13 Place of Birth: BORONGAN CITY

(Use separate sheet if necessary)

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

INTRAMURAL MEET MA. NELLY C. TABUENA

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: PADUA JHARED RICA C.

Date of Birth: (mm/dd/yyyy) 3-Jan-09 Age: 10 Place of Birth: BORONGAN CITY

(Use separate sheet if necessary)

JHARED RICA C. PADUA

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

DISTRICT MEET ROSEMARIE O. BASILIA

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Name: CARDONA GILBERT P.

Date of Birth: (mm/dd/yyyy) 6-Jun-02 Age: 17 Place of Birth: BORONGAN CITY

(Use separate sheet if necessary)

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

INTRAMURAL MEET JOSEFINA C. ARMA

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

Name: PORTILES JOHN REY G.

Sex: MALE Learner Reference Number (LRN) 122358120057 Contact Number

Date of Birth: (mm/dd/yyyy) 14-Jun-07 Age: 12 Place of Birth: BORONGAN CITY

(Use separate sheet if necessary)

PORTILES, JOHN REY G.

D. Certification on Athlete's Participation

Name and Signature of Division Name and Signature of

INTRAMURAL MEET JOSEFINA C. ARMA

(Use separate sheet if necessary)

Division Meet Regional Meet Palarong Pambansa

Date: ______________ Date: ______________ Date: ______________

Name: PADUA TRICIA LAINE C.

(Use separate sheet if necessary)

PADUA, TRICIA LAINE C.

D. Certification on Athlete's Participation

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __

Date: Date: Date: __