Revised as of September 26, 2019 VI - WESTERN VISAYAS
REGION
ILOILO
DIVISION
BASEBALL ELEMENTARY
EVENT
COACH/ASST. COACH RECORD
A. (CERTIFICATE OF TRAINING, RELEVANT COACHING EXPERIENCE )
B. APPOINTMENT (PUBLIC) / CONTRACT OF SERVICE (PRIVATE)
C. OMNIBUS AFFIDAVIT
Coach D. MEDICAL CERTIFICATE Assistant Coach
LINGAT, JOCELYN D. NAME GICOLE, MARITTEE B.
A. MONTES 1 ELEMENTARY SCHOOL SCHOOL A. MONTES 1 ELEMENTARY SCHOOL
A. CERTIFICATE OF COMMITMENT
B. MEDICAL CERTIFICATE
Chaperon
NAME
SCHOOL
A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED
AUJERO, RHAIN JUSTIN NAME OF ATHLETE DELARIARTE, PERCY PRINCE M.
442586160004 LRN 117626170025
12/14/2011 DATE OF BIRTH 11/18/2011
A. MONTES 1 ELEMENTARY SCHOOL SCHOOL A. MONTES 1 ELEMENTARY SCHOOL
A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED
DEALA, MARK JUN L. NAME OF ATHLETE ELPELOA, MARK REYLAND JR. A.
117626170056 LRN 117626170109
6/15/2011 DATE OF BIRTH 10/9/2011
A. MONTES 1 ELEMENTARY SCHOOL SCHOOL A. MONTES 1 ELEMENTARY SCHOOL
NOTE:
PLEASE USE A4 SIZE COPY PAPER
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
CE M.
JR. A.
Revised as of September 26, 2019 VI - WESTERN VISAYAS
REGION
ILOILO
DIVISION
BASEBALL ELEMENTARY
EVENT
A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED
FRANCO, NICOLO JAYSER J. NAME OF ATHLETE NACULANGGA, JULIUS O.
117626180140 LRN 117626170041
4/26/2013 DATE OF BIRTH 12/22/2011
A. MONTES 1 ELEMENTARY SCHOOL SCHOOL A. MONTES 1 ELEMENTARY SCHOOL
A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED
LEONORA, JUSTIN P. NAME OF ATHLETE SOCUBOS, MARBY JAMES H.
117626170096 LRN 117626170041
1/24/2012 DATE OF BIRTH 12/22/2011
A. MONTES 1 ELEMENTARY SCHOOL SCHOOL A. MONTES 1 ELEMENTARY SCHOOL
A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED
LLORENTE, SUNTINO S. NAME OF ATHLETE VICTORIANO, JOHN ALEXIS P.
117626180126 LRN 117626180067
1/24/2012 DATE OF BIRTH 4/24/2013
A. MONTES 1 ELEMENTARY SCHOOL SCHOOL A. MONTES 1 ELEMENTARY SCHOOL
A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED
MAPA, MARTHONY II P. NAME OF ATHLETE ZULUETA, LESTER GREEN P.
117626170029 LRN 117626170011
1/24/2012 DATE OF BIRTH 4/1/2012
A. MONTES 1 ELEMENTARY SCHOOL SCHOOL A. MONTES 1 ELEMENTARY SCHOOL
NOTE:
PLEASE USE A4 SIZE COPY PAPER
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
.
REGION
DIVISION
EVENT
A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED
NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL
A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED
NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL
A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
athlete athlete
G. DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED
NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL
A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DENTAL CERTIFICATE
DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED
NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL
NOTE:
PLEASE USE A4 SIZE COPY PAPER
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
