Revised as of September 26, 2019

Republic of the Philippines AR (ATHLETE RECORD)

DEPARTMENT OF EDUCATION
Region III - Central Luzon

SCHOOLS DIVISION OF CITY OF SAN JOSE DEL MONTE

Eco Park, Brgy. Muzon, City of San Jose del Monte
Latest 1½ x 1½ picture

A. PERSONAL DATA:

Name: PAHAMONOT PRINCES M M.

(Last) (First) (M.I.)

Sex: FEMALE Learner Reference Number (LRN) 107146160220 Contact Number 9989734750

Date of Birth: (mm/dd/yyyy) APRIL 28, 2010 Age: 12 Place of Birth: UC 4 BRGY. CITRUS, CITY OF SAN JOSE DEL MONTE BULACAN
School: BAGONG BUHAY G ELEMENTARY SCHOOL Grade Level GRADE 6
Address of School: BRGY. CITRUS, CITY OF SAN JOSE DEL MONTE BULACAN
Present Address: UC 4 BRGY. CITRUS, CITY OF SAN JOSE DEL MONTE BULACAN

Parents: NELSON DOSAL PAHAMONOT MERLITA NABUAL MABULAC

Fathers Name Mother/Guardian
Address of Parents/Guardian: UC 4 BRGY. CITRUS, CITY OF SAN JOSE DEL MONTE BULACAN

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
Intramurals/ District Meet
JANUARY 25, 2023 ATHLETICS Unit/ Cluster Meet FIRST PLACE
FEBRUARY 6-10, 2023 ATHLETICS Division/ Provincial/ City Meet FIRST PLACE
APRIL 24-28, 2023 ATHLETICS Regional Meet
Palarong Pambansa
Others
(Use separate sheet if necessary)

PAHAMONOT, PRINCES M M.
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 been a member of a school based club and has
participated in the lower meets.

Name and Signature of

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

Intramurals/ District Meet

Unit/ Cluster Meet ANA CARA MANALO

Division/ Provincial/ City Meet ANA CARA MANALO

Regional Meet EDUARD CARLO D. FERNANDEZ BERNADETTE B. ROSAROSO SAMMY P. SAMPANG

Palarong Pambansa Division Sports Officer Regional Sports Officer
Others
(Use separate sheet if necessary)

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)
Revised as of September 26, 2019

Republic of the Philippines AR (ATHLETE RECORD)

DEPARTMENT OF EDUCATION
Region III - Central Luzon

SCHOOLS DIVISION OF CITY OF SAN JOSE DEL MONTE

Eco Park, Brgy. Muzon, City of San Jose del Monte
Latest 1½ x 1½ picture

A. PERSONAL DATA:

Name: MATIENZO KIMBERLY MAE M.

(Last) (First) (M.I.)

Sex: FEMALE Learner Reference Number (LRN) 162510160222 Contact Number 9274498181

Date of Birth: (mm/dd/yyyy) FEBRUARY 27, 2011 Age: 11 Place of Birth: PHILIPPINE GENERAL HOSPITAL TAFT. AVE. MANILA
School: SAN JOSE DEL MONTE HEIGHTS ELEMENTARY SCHOOL Grade Level GRADE 6
Address of School: PH. 3 BRGY. MUZON, SAN JOSE DEL MONTE HEIGHTS, CITY OF SAN JOSE DEL MONTE BULACAN
Present Address: PH2 B35 L9,SJDM HEIGHTS,BRGY. MUZON, SAN JOSE DEL MONTE HEIGHTS, CITY OF SAN JOSE DEL MONTE BULACAN

Parents: GLENN RYAN C. MATIENZO ANALYN D. MALATE

Fathers Name Mother/Guardian
Address of Parents/Guardian: PH2 B35 L9,SJDM HEIGHTS,BRGY. MUZON, SAN JOSE DEL MONTE HEIGHTS, CITY OF SAN JOSE DEL MONTE BULACAN

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
Intramurals/ District Meet
JANUARY 25, 2023 ATHLETICS Unit/ Cluster Meet FIRST PLACE
FEBRUARY 6-10, 2023 ATHLETICS Division/ Provincial/ City Meet FIRST PLACE
APRIL 24-28, 2023 ATHLETICS Regional Meet
Palarong Pambansa
Others
(Use separate sheet if necessary)

MATIENZO, KIMBERLY MAE M.

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 been a member of a school based club and has
participated in the lower meets.

Name and Signature of

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

Intramurals/ District Meet

Unit/ Cluster Meet EDWIN S. JUNIO

Division/ Provincial/ City Meet EDWIN S. JUNIO

Regional Meet EDUARD CARLO D. FERNANDEZ BERNADETTE B. ROSAROSO SAMMY P. SAMPANG

Palarong Pambansa Division Sports Officer Regional Sports Officer
Others
(Use separate sheet if necessary)

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)
Revised as of September 26, 2019

Republic of the Philippines AR (ATHLETE RECORD)

DEPARTMENT OF EDUCATION
Region III - Central Luzon

SCHOOLS DIVISION OF CITY OF SAN JOSE DEL MONTE

Eco Park, Brgy. Muzon, City of San Jose del Monte
Latest 1½ x 1½ picture

A. PERSONAL DATA:

Name: GUMBAN CHRIST LOVELYN D.

(Last) (First) (M.I.)

Sex: FEMALE Learner Reference Number (LRN) 162510170285 Contact Number 9274498181

Date of Birth: (mm/dd/yyyy) JANUARY 8, 2012 Age: 11 Place of Birth: QUEZON CITY, MANILA
School: SAN JOSE DEL MONTE HEIGHTS ELEMENTARY SCHOOL Grade Level GRADE 5
Address of School: PH. 3 BRGY. MUZON, SAN JOSE DEL MONTE HEIGHTS, CITY OF SAN JOSE DEL MONTE BULACAN
Present Address: PH1 B3 LOT 11,SJDM HEIGHTS,BRGY. MUZON, SAN JOSE DEL MONTE HEIGHTS, CITY OF SAN JOSE DEL MONTE BULACAN

Parents: LOVEGELIO V. GUMBAN JR. JENALYN DOMINGO

Fathers Name Mother/Guardian
Address of Parents/Guardian: PH1 B3 LOT 11,SJDM HEIGHTS,BRGY. MUZON, SAN JOSE DEL MONTE HEIGHTS, CITY OF SAN JOSE DEL MONTE BULACAN

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
Intramurals/ District Meet
JANUARY 25, 2023 ATHLETICS Unit/ Cluster Meet FIRST PLACE
FEBRUARY 6-10, 2023 ATHLETICS Division/ Provincial/ City Meet FIRST PLACE
APRIL 24-28, 2023 ATHLETICS Regional Meet
Palarong Pambansa
Others
(Use separate sheet if necessary)

GUMBAN, CHRIST LOVELYN D.

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 been a member of a school based club and has
participated in the lower meets.

Name and Signature of

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

Intramurals/ District Meet

Unit/ Cluster Meet EDWIN S. JUNIO

Division/ Provincial/ City Meet EDWIN S. JUNIO

Regional Meet EDUARD CARLO D. FERNANDEZ BERNADETTE B. ROSAROSO SAMMY P. SAMPANG

Palarong Pambansa Division Sports Officer Regional Sports Officer
Others
(Use separate sheet if necessary)

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)
Revised as of September 26, 2019

Republic of the Philippines AR (ATHLETE RECORD)

DEPARTMENT OF EDUCATION
Region III - Central Luzon

SCHOOLS DIVISION OF CITY OF SAN JOSE DEL MONTE

Eco Park, Brgy. Muzon, City of San Jose del Monte
Latest 1½ x 1½ picture

A. PERSONAL DATA:

Name: TAÑAMOR NICA P.

(Last) (First) (M.I.)

Sex: FEMALE Learner Reference Number (LRN) 162510160222 Contact Number 9274498181

Date of Birth: (mm/dd/yyyy) NOVEMBER 8, 2010 Age: 12 Place of Birth: VALENZUELA CITY, MANILA
School: SAN JOSE DEL MONTE HEIGHTS ELEMENTARY SCHOOL Grade Level GRADE 6
Address of School: PH. 3 BRGY. MUZON, SAN JOSE DEL MONTE HEIGHTS, CITY OF SAN JOSE DEL MONTE BULACAN
Present Address: PH2 BLK 22 LOT 45, SJDM HEIGHTS,BRGY. MUZON, SAN JOSE DEL MONTE HEIGHTS, CITY OF SAN JOSE DEL MONTE BULACAN

Parents: BERNARD P TAÑAMOR MARLIN PESIDAS

Fathers Name Mother/Guardian
Address of Parents/Guardian: PH2 BLK 22 LOT 45, SJDM HEIGHTS,BRGY. MUZON, SAN JOSE DEL MONTE HEIGHTS, CITY OF SAN JOSE DEL MONTE BULACAN

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
Intramurals/ District Meet
JANUARY 25, 2023 ATHLETICS Unit/ Cluster Meet FIRST PLACE
FEBRUARY 6-10, 2023 ATHLETICS Division/ Provincial/ City Meet FIRST PLACE
APRIL 24-28, 2023 ATHLETICS Regional Meet
Palarong Pambansa
Others
(Use separate sheet if necessary)

TAÑAMOR, NICA P.
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 been a member of a school based club and has
participated in the lower meets.

Name and Signature of

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

Intramurals/ District Meet

Unit/ Cluster Meet EDWIN S. JUNIO

Division/ Provincial/ City Meet EDWIN S. JUNIO

Regional Meet EDUARD CARLO D. FERNANDEZ BERNADETTE B. ROSAROSO SAMMY P. SAMPANG

Palarong Pambansa Division Sports Officer Regional Sports Officer
Others
(Use separate sheet if necessary)

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)
Revised as of September 26, 2019

Republic of the Philippines AR (ATHLETE RECORD)

DEPARTMENT OF EDUCATION
Region III - Central Luzon

SCHOOLS DIVISION OF CITY OF SAN JOSE DEL MONTE

Eco Park, Brgy. Muzon, City of San Jose del Monte
Latest 1½ x 1½ picture

A. PERSONAL DATA:

Name: MANARES ARLIANE M.

(Last) (First) (M.I.)

Sex: FEMALE Learner Reference Number (LRN) 162502160017 Contact Number 9338114343

Date of Birth: (mm/dd/yyyy) MARCH 19, 2011 Age: 11 Place of Birth: CITY OF SAN JOSE DEL MONTE,BULACAN
School: RICAFORT ELEMENTARY SCHOOL Grade Level GRADE 6
Address of School: PUROK 8B, RICAFORT, TUNGKONG MANGGA, CITY OF SAN JOSE DEL MONTE, BULACAN
Present Address: PUROK 8B, RICAFORT, TUNGKONG MANGGA, CITY OF SAN JOSE DEL MONTE, BULACAN
Parents: ANTHONY F. MANARES MARIKAR A. MANALO
Fathers Name Mother/Guardian
Address of Parents/Guardian: PUROK 8B, RICAFORT, TUNGKONG MANGGA, CITY OF SAN JOSE DEL MONTE, BULACAN

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
Intramurals/ District Meet
01/25/2023 ATHLETICS Unit/ Cluster Meet FIRST PLACE
02/6-10/2023 ATHLETICS Division/ Provincial/ City Meet FIRST PLACE
04/24-28/2023 ATHLETICS Regional Meet
Palarong Pambansa
Others
(Use separate sheet if necessary)

MANARES, ARLIANE M.
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 been a member of a school based club and has
participated in the lower meets.

Name and Signature of

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

Intramurals/ District Meet

Unit/ Cluster Meet CHERYL E. DALUSUNG
Division/ Provincial/ City Meet EDUARD CARLO D. FERNANDEZ

Regional Meet EDUARD CARLO D. FERNANDEZ BERNADETTE B. ROSAROSO SAMMY P. SAMPANG

Palarong Pambansa Division Sports Officer Regional Sports Officer
Others
(Use separate sheet if necessary)

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)
Revised as of September 26, 2019

Republic of the Philippines AR (ATHLETE RECORD)

DEPARTMENT OF EDUCATION
Region III - Central Luzon

SCHOOLS DIVISION OF CITY OF SAN JOSE DEL MONTE

Eco Park, Brgy. Muzon, City of San Jose del Monte
Latest 1½ x 1½ picture

A. PERSONAL DATA:

Name: SALILICAN PRINCESS D.

(Last) (First) (M.I.)

Sex: FEMALE Learner Reference Number (LRN) 422523160024 Contact Number 9338114343

Date of Birth: (mm/dd/yyyy) FEBRUARY 20, 2010 Age: 12 Place of Birth: CITYOF SAN JOSE DEL MONTE , BULACAN
School: KAYPIAN ELEMETARY SCHOOL Grade Level GRADE 6
Address of School: KAYPIAN ROAD , BRGY. KAYPIAN , CITY OF SAN JOSE DEL MONTE BULACAN
Present Address: B27 L15, CARRISSA 4A, BRGY. KAYPIAN , CITY OF SAN JOSE DEL MONTE BULACAN
Parents: ARTHUR T. SALILICAN ROCEL T. DANTES
Fathers Name Mother/Guardian
Address of Parents/Guardian: B27 L15, CARRISSA 4A, BRGY. KAYPIAN , CITY OF SAN JOSE DEL MONTE BULACAN

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
Intramurals/ District Meet
JANUARY 25, 2023 ATHLETICS Unit/ Cluster Meet FIRST PLACE
FEBRUARY 6-10, 2023 ATHLETICS Division/ Provincial/ City Meet FIRST PLACE
APRIL 24-28, 2023 ATHLETICS Regional Meet
Palarong Pambansa
Others
(Use separate sheet if necessary)

SALILICAN, PRINCESS D.
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 been a member of a school based club and has
participated in the lower meets.

Name and Signature of

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

Intramurals/ District Meet

Unit/ Cluster Meet EDUARD CARLO D. FERNANDEZ

Division/ Provincial/ City Meet EDUARD CARLO D. FERNANDEZ

Regional Meet EDUARD CARLO D. FERNANDEZ BERNADETTE B. ROSAROSO SAMMY P. SAMPANG

Palarong Pambansa Division Sports Officer Regional Sports Officer
Others
(Use separate sheet if necessary)

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)
Revised as of September 26, 2019

Republic of the Philippines AR (ATHLETE RECORD)

DEPARTMENT OF EDUCATION
Region III - Central Luzon

SCHOOLS DIVISION OF CITY OF SAN JOSE DEL MONTE

Eco Park, Brgy. Muzon, City of San Jose del Monte
Latest 1½ x 1½ picture

A. PERSONAL DATA:

Name: DIVINAGRACIA JENEVA C.

(Last) (First) (M.I.)

Sex: FEMALE Learner Reference Number (LRN) 107157170273 Contact Number 9338114343

Date of Birth: (mm/dd/yyyy) FEBRUARY 7, 2012 Age: 10 Place of Birth: RARANAQUE CITY, METRO MANILA
School: KAYPIAN ELEMETARY SCHOOL Grade Level GRADE 5
Address of School: KAYPIAN ROAD , BRGY. KAYPIAN , CITY OF SAN JOSE DEL MONTE BULACAN
Present Address: B11, L3, CARRISSA 4B, BRGY. KAYPIAN , CITY OF SAN JOSE DEL MONTE BULACAN
Parents: BEN H. DIVINAGRACIA MELANIE C. DIVINAGRACIA
Fathers Name Mother/Guardian
Address of Parents/Guardian: B11, L3, CARRISSA 4B, BRGY. KAYPIAN , CITY OF SAN JOSE DEL MONTE BULACAN

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
Intramurals/ District Meet
JANUARY 25, 2023 ATHLETICS Unit/ Cluster Meet FIRST PLACE
FEBRUARY 6-10, 2023 ATHLETICS Division/ Provincial/ City Meet FIRST PLACE
APRIL 24-28, 2023 ATHLETICS Regional Meet
Palarong Pambansa
Others
(Use separate sheet if necessary)

DIVINAGRACIA, JENEVA C.
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 been a member of a school based club and has
participated in the lower meets.

Name and Signature of

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

Intramurals/ District Meet

Unit/ Cluster Meet EDUARD CARLO D. FERNANDEZ

Division/ Provincial/ City Meet EDUARD CARLO D. FERNANDEZ

Regional Meet EDUARD CARLO D. FERNANDEZ BERNADETTE B. ROSAROSO SAMMY P. SAMPANG

Palarong Pambansa Division Sports Officer Regional Sports Officer
Others
(Use separate sheet if necessary)

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)
Revised as of September 26, 2019

Republic of the Philippines AR (ATHLETE RECORD)

DEPARTMENT OF EDUCATION
Region III - Central Luzon

SCHOOLS DIVISION OF CITY OF SAN JOSE DEL MONTE

Eco Park, Brgy. Muzon, City of San Jose del Monte
Latest 1½ x 1½ picture

A. PERSONAL DATA:

Name: CEPE JILLIAN ERA T.

(Last) (First) (M.I.)

Sex: FEMALE Learner Reference Number (LRN) 107940170017 Contact Number 9338114343

Date of Birth: (mm/dd/yyyy) JANUARY 11, 2012 Age: 11 Place of Birth: GENERAL MARIANO ALVAREZ, CAVITE
School: KAYPIAN ELEMETARY SCHOOL Grade Level GRADE 5
Address of School: KAYPIAN ROAD , BRGY. KAYPIAN , CITY OF SAN JOSE DEL MONTE BULACAN
Present Address: MARCELO I,KABAN, BRGY. KAYPIAN , CITY OF SAN JOSE DEL MONTE BULACAN
Parents: RYAN C. CEPE MARJORIE U. TIMTIMAN
Fathers Name Mother/Guardian
Address of Parents/Guardian: MARCELO I,KABAN, BRGY. KAYPIAN , CITY OF SAN JOSE DEL MONTE BULACAN

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
Intramurals/ District Meet
JANUARY 25, 2023 ATHLETICS Unit/ Cluster Meet FIRST PLACE
FEBRUARY 6-10, 2023 ATHLETICS Division/ Provincial/ City Meet FIRST PLACE
APRIL 24-28, 2023 ATHLETICS Regional Meet
Palarong Pambansa
Others
(Use separate sheet if necessary)

CEPE, JILLIAN ERA T.

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 been a member of a school based club and has
participated in the lower meets.

Name and Signature of

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

Intramurals/ District Meet

Unit/ Cluster Meet EDUARD CARLO D. FERNANDEZ

Division/ Provincial/ City Meet EDUARD CARLO D. FERNANDEZ

Regional Meet EDUARD CARLO D. FERNANDEZ BERNADETTE B. ROSAROSO SAMMY P. SAMPANG

Palarong Pambansa Division Sports Officer Regional Sports Officer
Others
(Use separate sheet if necessary)

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)
Revised as of September 26, 2019

Republic of the Philippines AR (ATHLETE RECORD)

DEPARTMENT OF EDUCATION
Region III - Central Luzon

SCHOOLS DIVISION OF CITY OF SAN JOSE DEL MONTE

Eco Park, Brgy. Muzon, City of San Jose del Monte
Latest 1½ x 1½ picture

A. PERSONAL DATA:

Name: GERMONES IRISH JHOY V.

(Last) (First) (M.I.)

Sex: FEMALE Learner Reference Number (LRN) 136639160144 Contact Number 9153456603

Date of Birth: (mm/dd/yyyy) AUGUST 1, 2010 Age: 12 Place of Birth: BAGONG SILANG , CALOOCAN CITY
School: MARANGAL ELEMENTARY SCHOOL Grade Level GRADE 6
Address of School: TOWERVILLE6B, BRGY. GAYA-GAYA, CITY OF SAN JOSE DEL MONTE BULACAN
Present Address: BLK. 33 LOT12 BRGY. GAYA-GAYA, CITY OF SAN JOSE DEL MONTE BULACAN
Parents: PABLO Q. GERMONES JR. MARY ANN GERMONES
Fathers Name Mother/Guardian
Address of Parents/Guardian: BLK. 33 LOT12 BRGY. GAYA-GAYA, CITY OF SAN JOSE DEL MONTE BULACAN

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
Intramurals/ District Meet
JANUARY 25, 2023 ATHLETICS Unit/ Cluster Meet FIRST PLACE
FEBRUARY 6-10, 2023 ATHLETICS Division/ Provincial/ City Meet FIRST PLACE
APRIL 24-28, 2023 ATHLETICS Regional Meet
Palarong Pambansa
Others
(Use separate sheet if necessary)

GERMONES, IRISH JHOY V.

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 been a member of a school based club and has
participated in the lower meets.

Name and Signature of

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

Intramurals/ District Meet

Unit/ Cluster Meet GLENN FORD P. SAN DIEGO

Division/ Provincial/ City Meet EDUARD CARLO D. FERNANDEZ

Regional Meet EDUARD CARLO D. FERNANDEZ BERNADETTE B. ROSAROSO SAMMY P. SAMPANG

Palarong Pambansa Division Sports Officer Regional Sports Officer
Others
(Use separate sheet if necessary)

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)
Revised as of September 26, 2019

Republic of the Philippines AR (ATHLETE RECORD)

DEPARTMENT OF EDUCATION
Region III - Central Luzon

SCHOOLS DIVISION OF CITY OF SAN JOSE DEL MONTE

Eco Park, Brgy. Muzon, City of San Jose del Monte
Latest 1½ x 1½ picture

A. PERSONAL DATA:

Name: CASBADILLO CARL ROSE G.

(Last) (First) (M.I.)

Sex: FEMALE Learner Reference Number (LRN) 162508160220 Contact Number 9153456603

Date of Birth: (mm/dd/yyyy) MARCH 13, 2010 Age: 12 Place of Birth: NAVOTAS CITY, METRO MANILA
School: MARANGAL ELEMENTARY SCHOOL Grade Level GRADE 5
Address of School: TOWERVILLE6B, BRGY. GAYA-GAYA, CITY OF SAN JOSE DEL MONTE BULACAN
Present Address: BLK. 22, LOT 14 PH.6E BRGY. GAYA-GAYA, CITY OF SAN JOSE DEL MONTE BULACAN
Parents: CARLOS R. CASBADILLO ROSALYN G. CASBADILLO
Fathers Name Mother/Guardian
Address of Parents/Guardian: BLK. 22, LOT 14 PH.6E BRGY. GAYA-GAYA, CITY OF SAN JOSE DEL MONTE BULACAN

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
Intramurals/ District Meet
JANUARY 25, 2023 ATHLETICS Unit/ Cluster Meet FIRST PLACE
FEBRUARY 6-10, 2023 ATHLETICS Division/ Provincial/ City Meet FIRST PLACE
APRIL 24-28, 2023 ATHLETICS Regional Meet
Palarong Pambansa
Others
(Use separate sheet if necessary)

CASBADILLO, CARL ROSE G.

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 been a member of a school based club and has
participated in the lower meets.

Name and Signature of

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

Intramurals/ District Meet

Unit/ Cluster Meet GLENN FORD P. SAN DIEGO

Division/ Provincial/ City Meet EDUARD CARLO D. FERNANDEZ

Regional Meet EDUARD CARLO D. FERNANDEZ BERNADETTE B. ROSAROSO SAMMY P. SAMPANG

Palarong Pambansa Division Sports Officer Regional Sports Officer
Others
(Use separate sheet if necessary)

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)
Revised as of September 26, 2019

Republic of the Philippines AR (ATHLETE RECORD)

DEPARTMENT OF EDUCATION
Region III - Central Luzon

SCHOOLS DIVISION OF CITY OF SAN JOSE DEL MONTE

Eco Park, Brgy. Muzon, City of San Jose del Monte
Latest 1½ x 1½ picture

A. PERSONAL DATA:

Name:
(Last) (First) (M.I.)

Sex: Learner Reference Number (LRN) Contact Number

Date of Birth: (mm/dd/yyyy) Age: Place of Birth:

School: Grade Level
Address of School:
Present Address:
Parents:
Fathers Name Mother/Guardian
Address of Parents/Guardian:

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
Intramurals/ District Meet
Unit/ Cluster Meet
Division/ Provincial/ City Meet
Regional Meet
Palarong Pambansa
Others
(Use separate sheet if necessary)

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 been a member of a school based club and has
participated in the lower meets.

Name and Signature of

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

Intramurals/ District Meet

Unit/ Cluster Meet
Division/ Provincial/ City Meet
Regional Meet SAMMY P. SAMPANG
Palarong Pambansa Division Sports Officer Regional Sports Officer
Others
(Use separate sheet if necessary)

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)
Revised as of September 26, 2019

Republic of the Philippines AR (ATHLETE RECORD)

DEPARTMENT OF EDUCATION
Region III - Central Luzon

SCHOOLS DIVISION OF CITY OF SAN JOSE DEL MONTE

Eco Park, Brgy. Muzon, City of San Jose del Monte
Latest 1½ x 1½ picture

A. PERSONAL DATA:

Name: ANTIFONA CRIZTAL JANE G.

(Last) (First) (M.I.)

Sex: FEMALE Learner Reference Number (LRN) 107145170047 Contact Number 9989734750

Date of Birth: (mm/dd/yyyy) 11/15/2011 Age: 11 Place of Birth: CITY OF SAN JOSE DEL MONTE,BULACAN
School: BAGONG BUHAY F INTEGRATED SCHOOL Grade Level GRADE 5
Address of School: KARUNUNGAN STREET, BARANGAY SAN PEDRO AREA F, CITY OF SAN JOSE DEL MONTE, BULACAN
Present Address: BAGONG BUHAY B, CITY OF SAN JOSE DEL MONTE, BULACAN
Parents: RODOLF A. ANTIFONA JOAN KRIS G. ANTIFONA
Fathers Name Mother/Guardian
Address of Parents/Guardian: BAGONG BUHAY B, CITY OF SAN JOSE DEL MONTE, BULACAN

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
Intramurals/ District Meet
01/25/2023 ATHLETICS Unit/ Cluster Meet FIRST PLACE
02/6-10/2023 ATHLETICS Division/ Provincial/ City Meet FIRST PLACE
04/24-28/2023 ATHLETICS Regional Meet
Palarong Pambansa
Others
(Use separate sheet if necessary)

ANTIFONA, CRIZTAL JANE G.

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 been a member of a school based club and has
participated in the lower meets.

Name and Signature of

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

Intramurals/ District Meet

Unit/ Cluster Meet EDWIN C. DEQUIÑA
Division/ Provincial/ City Meet EDWIN C. DEQUIÑA
Regional Meet EDUARD CARLO D. FERNANDEZ BERNADETTE B. ROSAROSO SAMMY P. SAMPANG
Palarong Pambansa Division Sports Officer Regional Sports Officer
Others
(Use separate sheet if necessary)

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)