Revised as of September 26, 2019
AR (ATHLETE RECORD)
                                                                      REGION X
                                                                      Region
                                                            MISAMIS ORIENTAL
                                                                                                                               Latest 1½ x 1½ picture
                                                                      Division
A. PERSONAL DATA:
                                    Name:               SARDA                                                   RUTH JEAN                                T.
                                                          (Last)                               (First)                                                                     (M.I.)
                                      Sex: FEMALE        Learner Reference Number (LRN)                  127866130210                   Contact Number
   Date of Birth: (mm/dd/yyyy)                         11/15/2007                   Age:      16                      Place of Birth:            TAGOLOAN, MIS. OR.
                          School:                      CASINGLOT NATIONAL HIGH SCHOOL                                                    Grade Level         10
               Address of School:                          CASINGLOT, TAGOLOAN, MISAMIS ORIENTAL
                     Present Address:               CASINGLOT, TAGOLOAN, MISAMIS ORIENTAL
                                   Parents:           NUMERIANO P. SARDA                                                                     JENNIE T. SARDA
                                                            Fathers Name                                                                       Mother/Guardian
    Address of Parents/Guardian:                           CASINGLOT, TAGOLOAN, MISAMIS ORIENTAL
                                                                   √ . If Yes, kindly fill up the table below
B. Participation in the previous Palarong Pambansa. Yes ____ No _____
          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
                7/11/2023                            BASKETBALL                                            INTRAMURALS                                           SILVER
               11/24/2023                            BASKETBALL                                            DISTRICT MEET                                          GOLD
               11/30/2023                            BASKETBALL                                           MUNICIPAL MEET                                          GOLD
(Use separate sheet if necessary)
                                                                                                             RUTH JEAN T. SARDA
                                                                                                         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 participated in the lower meets.
                                                                                                                    Name and Signature of Division    Name and Signature of
                             Meet                                   Name and Signature of Coach
                                                                                                                        Sports Officer (DSO)       Regional Sports Officer (RSO)
                      INTRAMURALS                                  CLAUDINE DIANE T. PAPAURAN
                     DISTRICT MEET                                 CLAUDINE DIANE T. PAPAURAN
                    MUNICIPAL MEET                                 CLAUDINE DIANE T. PAPAURAN
(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)