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General Information: Lastname Firstname M.I

The document provides information about Raymart Polo, a 12-year-old male athlete from Gubat North Central School who will compete in Athletics for elementary boys at the Balogo Sports Complex from November 5-7, 2014. It includes details about Raymart's school, medical certification, participation in previous district and zonal athletic meets, and coaches.

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Joseph Ferreras-Guardian Eva-Escober
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68 views3 pages

General Information: Lastname Firstname M.I

The document provides information about Raymart Polo, a 12-year-old male athlete from Gubat North Central School who will compete in Athletics for elementary boys at the Balogo Sports Complex from November 5-7, 2014. It includes details about Raymart's school, medical certification, participation in previous district and zonal athletic meets, and coaches.

Uploaded by

Joseph Ferreras-Guardian Eva-Escober
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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GENERAL INFORMATION

VENUE
REGION
DIVISION
SCHOOL YEAR
DATE

:
:
:
:
:

Balogo Sports Complex


V
Sorsogon
2014-2015
November 5-7, 2014

PLAYER'S INFORMATION
LEVEL

: Elementary
Lastname

NAME OF ATHLETE

FirstName

Raymart

Polo
EVENT: : Athletics Elementary Boys
GENDER: : Male
B-DATE

NAME OF SCHOOL:

:
:
:
:
:
:
:
:
:
:
:
:

SCHOOL TYPE
LRN:
SCHOOL ADDRESS
PLACE OF BIRTH
AGE
FATHER'S NAME
MOTHER'S NAME
PARENT'S ADDRESS
GUARDIAN'S NAME
GUARDIAN'S ADDRESS
RELATIONSHIP
PRINCIPAL

MONTH

April
Gubat North Central School
Central School
114192090180
Pinontingan, Gubat, Sorsogon
Gubat, Sorsogon
12
Retchie Polo
Presie Polo
Payawin, Gubat, Sorsogon
N/A
N/A
N/A
GENELITA A. NANTIZA

M.I

DAY

YEAR

2002

OTHER DATA
COACH
SCHOOL
CHAPERON
SCHOOL
DIVISION SCREENING
REGIONAL SCREENING
SCHOOL HEAD
TEACHER-ADVISE/REGISTRAR
DENTIST (DIVISION)
PHYSICIAN DIVISION

: Joseph G. Escober
:
:
:
:
:
:
:
:
:

Patag Elementary School

Screening,School Chairman
Chairman, District Level

Lara E. Estayan
Arlene Ainza
Anthony Lelis

ATHLETE'S PARTICIPATION IN LOCAL/INTERNATIONAL COMPETITION


Inclusive Dates

September 12-13,
2014
September 26-27,
2014

Sports Event

Athletics
Elementary
Athletics
Elementary

Athletic Meet

Remark
s

District
Meet

1st

Josefina Acua

Zonal Meet

2nd

Joseph G.
Escober

Coaches

Division PESS
Supervisor

Anacleto B. Otivar
Anacleto B. Otivar

Republic of the Philippines


Department of Education
Region V
Division Sorsogo
of n
Patag Elementary School
(School)

MEDICAL CERTIFICATE
_______________
(Date)

To Whom It May Concern:

This is to certify that I have personally examined

Joseph G. Escober
Name

age

30

sex

Male

born on

January 5, 1984

and have found that he/she is

physically fit, during the time of examination, to join and compete in the Lower Meets and

Palarong Pambansa.

Event:

Athletics Elementary Boys

Physical Examination
Date examined:

Height:
Pulse, Resting:
Other Remarks:

Weight
:

Blood Pressure:
Respiratory
Rate:

Physician/Medical Officer
(Signature over printed name)

License No. :
PTR.
:
Date:

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