Revised July 2019

AR-I (ATHLETE RECORD)

IV-A- CALABARZON
Region

LIPA CITY
Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: ESTOESTA JOSEPH ANGELO O.

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

Sex: Male Learner Reference Number (LRN) 136596 090251 Contact Number 9979286760

Date of Birth: (mm/dd/yyyy) 12-15-03 Age: 15 Place of Birth: Villamor Air Base Pasay City

School: LIPA MONTESSORI SCHOOL OF LEARNING INC. Grade Level Grade 10

Address of School: TRANSVILLE HOMES BANAYBANAY , LIPA CITY
Present Address: BLOOMFIELD HOMES TAMBO , LIPA CITY
Parents: JOSEPH U. ESTOESTA JOSEPHINE O. ESTOESTA
Fathers Name Mother/Guardian
Address of Parents: BLOOMFIELD HOMES TAMBO , LIPA CITY

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 Local/International Competition (For the Current School Year)

Inclusive Dates Sports Event Athletic Meet Remarks
March - May 2019 Sotero Cup

(Use separate sheet if necessary)

Athlete Signature over Printed Name

D. Certification on Athlete's Participation

This is to certify that based on our knowledge the above-mentioned athlete has participated in the lower meets.

Name and Signature of Name and Signature of

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

(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 July 2019

AR-I (ATHLETE RECORD)

IV-A- CALABARZON
Region

LIPA CITY
L
Division

A. PERSONAL DATA:

Name: ANDAYA ANGELO U.

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

Sex: M Learner Reference Number (LRN) 401615 150238 Contact Number 9457675223

Date of Birth: (mm/dd/yyyy) 12-15-02 Age: 16 Place of Birth: LIPA CITY

School: LIPA MONTESSORI SCHOOL OF LEARNING INC. Grade Level Grade 11

Address of School: TRANSVILLE HOMES BANAYBANAY , LIPA CITY
Present Address: SICO LIPA CITY
Parents: RONALD ANDAYA GLENDA ANDAYA
Fathers Name Mother/Guardian
Address of Parents: SICO LIPA CITY

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 Local/International Competition (For the Current School Year)

Inclusive Dates Sports Event Athletic Meet Remarks
March - May 2019 Sotero Cup

(Use separate sheet if necessary)

Athlete Signature over Printed Name

D. Certification on Athlete's Participation

This is to certify that based on our knowledge the above-mentioned athlete has participated in the lower meets.

Name and Signature of Name and Signature of

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

(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 July 2019

AR-I (ATHLETE RECORD)

IV-A- CALABARZON
Region

LIPA CITY
Division

A. PERSONAL DATA:

Name: MARANAN STEPHEN MATTHEW V.

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

Sex: Male Learner Reference Number (LRN) Contact Number 9065348063

Date of Birth: (mm/dd/yyyy) 03-21-03 Age: 16 Place of Birth: LIPA CITY

School: LIPA MONTESSORI SCHOOL OF LEARNING INC. Grade Level Grade 10

Address of School: TRANSVILLE HOMES BANAYBANAY , LIPA CITY
Present Address: BANAYBANAY LIPA CITY
Parents: SONY MARANAN IRENE MARANAN
Fathers Name Mother/Guardian
Address of Parents: BANAYBANAY LIPA CITY

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 Local/International Competition (For the Current School Year)

Inclusive Dates Sports Event Athletic Meet Remarks
March - May 2019 Sotero Cup

(Use separate sheet if necessary)

Athlete Signature over Printed Name

D. Certification on Athlete's Participation

This is to certify that based on our knowledge the above-mentioned athlete has participated in the lower meets.

Name and Signature of Name and Signature of

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

(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 July 2019

AR-I (ATHLETE RECORD)

IV-A- CALABARZON
Region

LIPA CITY
Division

A. PERSONAL DATA:

Name: NORCIO JON ALECKS R.

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

Sex: Male Learner Reference Number (LRN) 10969 7090107 Contact Number 9067911364

Date of Birth: (mm/dd/yyyy) 08-19-04 Age: 15 Place of Birth: LIPA CITY

School: LIPA MONTESSORI SCHOOL OF LEARNING INC. Grade Level Grade 10

Address of School: TRANSVILLE HOMES BANAYBANAY , LIPA CITY
Present Address: ST. MATTHEWS BANAYBANAY LIPA CITY
Parents: RICKY G. NORCIO JONALYN R. NORCIO
Fathers Name Mother/Guardian
Address of Parents: ST. MATTHEWS BANAYBANAY LIPA CITY

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 Local/International Competition (For the Current School Year)

Inclusive Dates Sports Event Athletic Meet Remarks
March - May 2019 Sotero Cup

(Use separate sheet if necessary)

Athlete Signature over Printed Name

D. Certification on Athlete's Participation

This is to certify that based on our knowledge the above-mentioned athlete has participated in the lower meets.

Name and Signature of Name and Signature of

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

(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 July 2019

AR-I (ATHLETE RECORD)

IV-A- CALABARZON
Region

LIPA CITY
Division

A. PERSONAL DATA:

Name: RODELAS CHARLES ANGELO L.

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

Sex: MALE Learner Reference Number (LRN) 40321 5150327 Contact Number 9568571400

Date of Birth: (mm/dd/yyyy) 03-27-03 Age: 16 Place of Birth: LIPA CITY

School: LIPA MONTESSORI SCHOOL OF LEARNING INC. Grade Level Grade 10

Address of School: TRANSVILLE HOMES BANAYBANAY , LIPA CITY
Present Address: ST. MATTHEWS BANAYBANAY LIPA CITY
Parents: GALLILEO RODELAS ANNABELLE RODELAS
Fathers Name Mother/Guardian
Address of Parents: BLOOMFIELD HOMES TAMBO , LIPA CITY

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 Local/International Competition (For the Current School Year)

Inclusive Dates Sports Event Athletic Meet Remarks
March - May 2019 Sotero Cup

(Use separate sheet if necessary)

Athlete Signature over Printed Name

D. Certification on Athlete's Participation

This is to certify that based on our knowledge the above-mentioned athlete has participated in the lower meets.

Name and Signature of Name and Signature of

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

(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 July 2019

AR-I (ATHLETE RECORD)

IV-A- CALABARZON
Region

LIPA CITY
Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: DIMACULANGAN OSLEC EUSEB C.

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

Sex: Male Learner Reference Number (LRN) 109697 130141 Contact Number 9198905311

Date of Birth: (mm/dd/yyyy) 10/5/2007 Age: 12 Place of Birth: LIPA CITY

School: LIPA MONTESSORI SCHOOL OF LEARNING INC. Grade Level Grade 7

Address of School: TRANSVILLE HOMES BANAYBANAY , LIPA CITY
Present Address: BANAYBANAY LIPA CITY
Parents: BOBET DIMACULANGAN JAYCEL DIMACULANGAN
Fathers Name Mother/Guardian
Address of Parents: BANAYBANAY LIPA CITY

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 Local/International Competition (For the Current School Year)

Inclusive Dates Sports Event Athletic Meet Remarks

(Use separate sheet if necessary)

Athlete Signature over Printed Name

D. Certification on Athlete's Participation

This is to certify that based on our knowledge the above-mentioned athlete has participated in the lower meets.

Name and Signature of Name and Signature of

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

(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 July 2019

AR-I (ATHLETE RECORD)

IV-A- CALABARZON
Region

LIPA CITY
Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: MENDOZA KURT JOHNDRICK O.

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

Sex: Male Learner Reference Number (LRN) 403203 151413 Contact Number 9560775856

Date of Birth: (mm/dd/yyyy) 2/8/2003 Age: 16 Place of Birth: LIPA CITY

School: LIPA MONTESSORI SCHOOL OF LEARNING INC. Grade Level GRADE 11

Address of School: TRANSVILLE HOMES BANAYBANAY , LIPA CITY
Present Address: TAMBO LIPA CITY
Parents: DONALD E. MENDOZA JUDITH O. MENDOZA
Fathers Name Mother/Guardian
Address of Parents: TAMBO LIPA CITY

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 Local/International Competition (For the Current School Year)

Inclusive Dates Sports Event Athletic Meet Remarks

(Use separate sheet if necessary)

Athlete Signature over Printed Name

D. Certification on Athlete's Participation

This is to certify that based on our knowledge the above-mentioned athlete has participated in the lower meets.

Name and Signature of Name and Signature of

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

(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 July 2019

AR-I (ATHLETE RECORD)

IV-A- CALABARZON
Region

LIPA CITY
Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: CALA JAMES KEVIN D.

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

Sex: Male Learner Reference Number (LRN) 4032151 50078 Contact Number 9205153000

Date of Birth: (mm/dd/yyyy) 10-18-03 Age: 15 Place of Birth: LIPA CITY

School: LIPA MONTESSORI SCHOOL OF LEARNING INC. Grade Level Grade 10

Address of School: TRANSVILLE HOMES BANAYBANAY , LIPA CITY
Present Address: TRANSVILLE HOMES BANAYBANAY , LIPA CITY
Parents: BRIGIDO M. CALA MICHELLE D. CALA
Fathers Name Mother/Guardian
Address of Parents: TRANSVILLE HOMES BANAYBANAY , LIPA CITY

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 Local/International Competition (For the Current School Year)

Inclusive Dates Sports Event Athletic Meet Remarks
March - May 2019 Sotero Cup

(Use separate sheet if necessary)

Athlete Signature over Printed Name

D. Certification on Athlete's Participation

This is to certify that based on our knowledge the above-mentioned athlete has participated in the lower meets.

Name and Signature of Name and Signature of

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

(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 July 2019

AR-I (ATHLETE RECORD)

IV-A- CALABARZON
Region

LIPA CITY
Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: LAZO IVAN REEVE J.

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

Sex: M Learner Reference Number (LRN) 403215 150163 Contact Number 9668000052

Date of Birth: (mm/dd/yyyy) 04-29-03 Age: 16 Place of Birth: LIPA CITY

School: LIPA MONTESSORI SCHOOL OF LEARNING INC. Grade Level Grade 11

Address of School: TRANSVILLE HOMES BANAYBANAY , LIPA CITY
Present Address: BANAYBANAY LIPA CITY
Parents: RODEL C. LAZO IMELDA J. LAZO
Fathers Name Mother/Guardian
Address of Parents: BANAYBANAY LIPA CITY

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 Local/International Competition (For the Current School Year)

Inclusive Dates Sports Event Athletic Meet Remarks
March - May 2019 Sotero Cup

(Use separate sheet if necessary)

Athlete Signature over Printed Name

D. Certification on Athlete's Participation

This is to certify that based on our knowledge the above-mentioned athlete has participated in the lower meets.

Name and Signature of Name and Signature of

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

(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 July 2019

AR-I (ATHLETE RECORD)

IV-A- CALABARZON
Region

LIPA CITY
Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: MERCADO JAN BUTCH T.

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

Sex: M Learner Reference Number (LRN) Contact Number 9153534005

Date of Birth: (mm/dd/yyyy) 8/6/2003 Age: 16 Place of Birth: LIPA CITY

School: LIPA MONTESSORI SCHOOL OF LEARNING INC. Grade Level Grade 11

Address of School: TRANSVILLE HOMES BANAYBANAY , LIPA CITY
Present Address: BANAYBANAY LIPA CITY
Parents: HENRY D. MERCADO JANET T. MERCADO
Fathers Name Mother/Guardian
Address of Parents: BANAYBANAY LIPA CITY

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 Local/International Competition (For the Current School Year)

Inclusive Dates Sports Event Athletic Meet Remarks
March - May 2019 Sotero Cup

(Use separate sheet if necessary)

Athlete Signature over Printed Name

D. Certification on Athlete's Participation

This is to certify that based on our knowledge the above-mentioned athlete has participated in the lower meets.

Name and Signature of Name and Signature of

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

(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 July 2019

AR-I (ATHLETE RECORD)

IV-A- CALABARZON
Region

LIPA CITY
Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: CARIAGA JOHN VINCENT P.

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

Sex: M Learner Reference Number (LRN) 1096970 80034 Contact Number 9550844387

Date of Birth: (mm/dd/yyyy) 8/4/2002 Age: 17 Place of Birth: LIPA CITY

School: LIPA MONTESSORI SCHOOL OF LEARNING INC. Grade Level Grade 11

Address of School: TRANSVILLE HOMES BANAYBANAY , LIPA CITY
Present Address: BANAYBANAY LIPA CITY
Parents: ELY CARIAGA EMELITA CARIAGA
Fathers Name Mother/Guardian
Address of Parents: BANAYBANAY LIPA CITY

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 Local/International Competition (For the Current School Year)

Inclusive Dates Sports Event Athletic Meet Remarks
March - May 2019 Sotero Cup

(Use separate sheet if necessary)

Athlete Signature over Printed Name

D. Certification on Athlete's Participation

This is to certify that based on our knowledge the above-mentioned athlete has participated in the lower meets.

Name and Signature of Name and Signature of

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

(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 July 2019

AR-I (ATHLETE RECORD)

IV-A- CALABARZON
Region

LIPA CITY
Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: LAYLO IVAN V.

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

Sex: Male Learner Reference Number (LRN) 40320 3151569 Contact Number 9950270564

Date of Birth: (mm/dd/yyyy) 9/4/2002 Age: 17 Place of Birth: LIPA CITY

School: LIPA MONTESSORI SCHOOL OF LEARNING INC. Grade Level GRADE 11

Address of School: TRANSVILLE HOMES BANAYBANAY , LIPA CITY
Present Address: BANAYBANAY LIPA CITY
Parents: GODOFREDO LAYLO LINDA LAYLO
Fathers Name Mother/Guardian
Address of Parents: BANAYBANAY LIPA CITY

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 Local/International Competition (For the Current School Year)

Inclusive Dates Sports Event Athletic Meet Remarks
March - May 2019 Sotero Cup

(Use separate sheet if necessary)

Athlete Signature over Printed Name

D. Certification on Athlete's Participation

This is to certify that based on our knowledge the above-mentioned athlete has participated in the lower meets.

Name and Signature of Name and Signature of

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

(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)