REGION VII

REGION
SECONDARY LEVEL
LEVEL
BASKETBALL 5X5
EVENT
ATHLETE'S RECORD
ORIGINAL PSA BIRTH CERTIFICATE
SF 10

CERTIFICATE OF ENROLMENT AND ATTENDANCE/COMPLETION

PARENTAL CONSENT
ATHLETE 5 ATHLETE 9
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED

ETCUBAN, LAURENCE NAME OF ATHLETE PANCHO, ZHANNEL C.

05-21-2006 DATE OF BIRTH 09-25-2007
ZAPATERA NHS SCHOOL ZAPATERA NHS
119931110093 LEARNERS REFERENCE NUMBER (LRN) 119931120080
9328476589 CONTACT NUMBER 9938881171

ATHLETE'S RECORD
ORIGINAL PSA BIRTH CERTIFICATE
SF 10

CERTIFICATE OF ENROLMENT AND ATTENDANCE/COMPLETION

PARENTAL CONSENT
ATHLETE 6 ATHLETE 10
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED

GLIPA, FRANCES GABRIEL NAME OF ATHLETE POCDOL, ACE ALEXIS C.

12-09-2005 DATE OF BIRTH 06-10-2006
ZAPATERA NHS SCHOOL ZAPATERA NHS
1199311130441 LEARNERS REFERENCE NUMBER (LRN) 404365150128
998553176 CONTACT NUMBER 9285593171
ATHLETE'S RECORD
ORIGINAL PSA BIRTH CERTIFICATE
SF 10

CERTIFICATE OF ENROLMENT AND ATTENDANCE/COMPLETION

PARENTAL CONSENT
ATHLETE 7 ATHLETE 11
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED

LIM, JADE ICKER M. NAME OF ATHLETE SECUYA, LUKE KENEDIE L.

10-23-2005 DATE OF BIRTH 02-05-2005
ZAPATERA NHS SCHOOL ZAPATERA NHS
119931140625 LEARNERS REFERENCE NUMBER (LRN) 119931100441
918559318 CONTACT NUMBER 9385593176
ATHLETE'S RECORD
ORIGINAL PSA BIRTH CERTIFICATE
SF 10

CERTIFICATE OF ENROLMENT AND ATTENDANCE/COMPLETION

PARENTAL CONSENT
ATHLETE 8 ATHLETE 12
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
INTERVIEWED

MELENDRES, JOSEPH BRYANT EARL R. NAME OF ATHLETE YANGCO, ROLLY C.

07-31-2006 DATE OF BIRTH 12-19-2006
ZAPATERA NHS SCHOOL ZAPATERA NHS
118064110016 LEARNERS REFERENCE NUMBER (LRN) 136596141331
9985593176 CONTACT NUMBER 9385593176
 VII
REGION
ELEMENTARY
LEVEL

EVENT

CACR (COACH /ASST.COACH RECORD)

CERTIFICATE OF EMPLOYMENT

APPOINTMENT (PUBLIC) / CONTRACT OF SERVICE ( PRIVATE)

OMNIBUS AFFIDAVIT
COACH PERSONAL DATA SHEET ASST. COACH

MEDICAL CERTIFICATE
CERTIFICATE OF TRAINING
CERTIFICATE OF SPORTS MEMBERSHIP
CERT. OF SPORTS RECOGNITION IN LOWER MEETS

NAME
SCHOOL
DATE OF BIRTH
CONTACT NUMBER

PERSONAL DATA SHEET

MEDICAL CERTIFICATE

CERTIFICATE OF COMMITMENT

CHAPERON

NAME
SCHOOL
DATE OF BIRTH
CONTACT NUMBER

ATHLETE'S RECORD
ORIGINAL PSA BIRTH CERTIFICATE
SF 10 / FORM 137

CERTIFICATE OF ENROLMENT AND ATTENDANCE/COMPLETION

ATHLETE1 PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & ATHLETE 3

CUSTODY
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES only)
INTERVIEWED
NAME OF ATHLETE
DATE OF BIRTH
SCHOOL
LEARNERS REFERENCE NUMBER (LRN)
CONTACT NUMBER

ATHLETE'S RECORD
ORIGINAL PSA BIRTH CERTIFICATE
SF 10 / FORM 137

CERTIFICATE OF ENROLMENT AND ATTENDANCE/COMPLETION

ATHLETE 2 PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & ATHLETE 4

CUSTODY
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES only)
INTERVIEWED
NAME OF ATHLETE
DATE OF BIRTH
SCHOOL
LEARNERS REFERENCE NUMBER (LRN)
CONTACT NUMBER

REGION

LEVEL

EVENT
 ATHLETE'S RECORD
ORIGINAL PSA BIRTH CERTIFICATE
SF 10 / FORM 137

CERTIFICATE OF ENROLMENT AND ATTENDANCE/COMPLETION

PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE &
ATHLETE 5 CUSTODY ATHLETE 9
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES only)
INTERVIEWED

NAME OF ATHLETE
DATE OF BIRTH
SCHOOL
LEARNERS REFERENCE NUMBER (LRN)
CONTACT NUMBER

ATHLETE'S RECORD
ORIGINAL PSA BIRTH CERTIFICATE
SF 10 / FORM 137

CERTIFICATE OF ENROLMENT AND ATTENDANCE/COMPLETION

PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE &
ATHLETE 6 CUSTODY ATHLETE 10
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES only)
INTERVIEWED

NAME OF ATHLETE
DATE OF BIRTH
SCHOOL
LEARNERS REFERENCE NUMBER (LRN)
CONTACT NUMBER

ATHLETE'S RECORD
ORIGINAL PSA BIRTH CERTIFICATE
SF 10 / FORM 137

CERTIFICATE OF ENROLMENT AND ATTENDANCE/COMPLETION

PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE &
ATHLETE 7 CUSTODY ATHLETE 11
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES only)
INTERVIEWED

NAME OF ATHLETE
DATE OF BIRTH
SCHOOL
LEARNERS REFERENCE NUMBER (LRN)
CONTACT NUMBER
ATHLETE'S RECORD
ORIGINAL PSA BIRTH CERTIFICATE
SF 10 / FORM 137

CERTIFICATE OF ENROLMENT AND ATTENDANCE/COMPLETION

PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE &
ATHLETE 8 CUSTODY ATHLETE 12
MEDICAL CERTIFICATE
DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES only)
INTERVIEWED

NAME OF ATHLETE
DATE OF BIRTH
SCHOOL
LEARNERS REFERENCE NUMBER (LRN)
CONTACT NUMBER