For Screening

Download as xlsx, pdf, or txt
Download as xlsx, pdf, or txt
You are on page 1of 2

EVENT:

COACH/ASST. COACH RECORD REMARKS CHAPERON REMARKS


NAME NAME
SCHOOL SCHOOL
APPOINTMENT/EMPLOYMENT/CONTRACT APPOINTMENT/EMPLOYMENT/
OF SERVICE CONTRACT OF SERVICE
OMNIBUS AFFIDAVIT CERTIFICATE OF COMMITMENT
MEDICAL CERTIFICATE MEDICAL CERTIFICATE
CERTIFICATE OF TRAINING

CERTIFICATE OF SPORTS MEMBERSHIP NAME OF ATHLETE

LICENSE OR CERTIFICATIONS/
LRN
ACCREDITATION

DATE OF BIRTH

SCHOOL
NAME OF ATHLETE AR (ATHLETE'S RECORD)
LRN ORIGINAL COPY OF PSA/NSO
DATE OF BIRTH SF 10 / FORM - 137
CERTIFICATE OF ATTENDANCE (for
SCHOOL
Palarong Pambansa Only)

PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT


AR (ATHLETE'S RECORD) OF ACTUAL CARE & CUSTODY

ORIGINAL COPY OF PSA/NSO MEDICAL CERTIFICATE


SF 10 / FORM - 137 DENTAL CERTIFICATE
CERTIFICATE OF ATTENDANCE (for DISABILITY ASSESSMENT (for
Palarong Pambansa Only) PARAGAMES Only)

PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT


OF ACTUAL CARE & CUSTODY

MEDICAL CERTIFICATE

DENTAL CERTIFICATE NAME OF ATHLETE


DISABILITY ASSESSMENT (for
LRN
PARAGAMES Only)
DATE OF BIRTH

NAME OF ATHLETE SCHOOL

LRN AR (ATHLETE'S RECORD)

DATE OF BIRTH ORIGINAL COPY OF PSA/NSO

SCHOOL SF 10 / FORM - 137

CERTIFICATE OF ATTENDANCE (for


AR (ATHLETE'S RECORD)
Palarong Pambansa Only)

PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT


ORIGINAL COPY OF PSA/NSO OF ACTUAL CARE & CUSTODY

SF 10 / FORM - 137 MEDICAL CERTIFICATE

CERTIFICATE OF ATTENDANCE (for


DENTAL CERTIFICATE
Palarong Pambansa Only)

PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT DISABILITY ASSESSMENT (for


OF ACTUAL CARE & CUSTODY PARAGAMES Only)

MEDICAL CERTIFICATE

DENTAL CERTIFICATE NAME OF ATHLETE

DISABILITY ASSESSMENT (for


LRN
PARAGAMES Only)
DATE OF BIRTH
NAME OF ATHLETE SCHOOL

LRN AR (ATHLETE'S RECORD)

DATE OF BIRTH ORIGINAL COPY OF PSA/NSO


SCHOOL SF 10 / FORM - 137
CERTIFICATE OF ATTENDANCE (for
AR (ATHLETE'S RECORD)
Palarong Pambansa Only)

PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT


ORIGINAL COPY OF PSA/NSO OF ACTUAL CARE & CUSTODY

SF 10 / FORM - 137 MEDICAL CERTIFICATE


CERTIFICATE OF ATTENDANCE (for
DENTAL CERTIFICATE
Palarong Pambansa Only)

PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT DISABILITY ASSESSMENT (for


OF ACTUAL CARE & CUSTODY PARAGAMES Only)

MEDICAL CERTIFICATE
DENTAL CERTIFICATE SCREENED BY:
DISABILITY ASSESSMENT (for
PARAGAMES Only)

You might also like