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The document outlines the requirements for participation in a 3x3 basketball event for secondary girls in Region VI - Western Visayas, Cadiz City Division. It lists the documents required for coaches/assistant coaches, athletes, and chaperones. These include appointment records, medical certificates, parental consent forms, and copies of government IDs. It also provides spaces to record the names, school, and other details of participating athletes. The note at the bottom indicates this is for school sports competitions up to the Palarong Pambansa level.

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Alyzza Grace Azucena
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98 views5 pages

Gallery

The document outlines the requirements for participation in a 3x3 basketball event for secondary girls in Region VI - Western Visayas, Cadiz City Division. It lists the documents required for coaches/assistant coaches, athletes, and chaperones. These include appointment records, medical certificates, parental consent forms, and copies of government IDs. It also provides spaces to record the names, school, and other details of participating athletes. The note at the bottom indicates this is for school sports competitions up to the Palarong Pambansa level.

Uploaded by

Alyzza Grace Azucena
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Revised as of APRIL 3, 2023 VI - WESTREN VISAYAS

REGION
CADIZ CITY
DIVISION

BASKETBALL 3X3 - SECONDARY GIRLS


EVENT

A. COACH/ASST. COACH RECORD


B. APPOINTMENT/EMPLOYMENT/CONTRACT OF SERVICE
C. OMNIBUS AFFIDAVIT
D. MEDICAL CERTIFICATE
Coach Assistant Coach
E CERTIFICATE OF TRAINING
F CERTIFICATE OF SPORTS MEMBERSHIP
G LICENSE OR CERTIFICATIONS/ ACCREDITATION

NAME
VILLACIN NATIONAL HIGH SCHOOL SCHOOL

A. APPOINTMENT/EMPLOYMENT/CONTRACT OF SERVICE
B. CERTIFICATE OF COMMITMENT
C. MEDICAL CERTIFICATE

Chaperon

NAME
SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

SEVELLEJO, IAN B. NAME OF ATHLETE


117542150030 LRN 117543120033
06/16/2010 DATE OF BIRTH 5/12/2007
VILLACIN NATIONAL HIGH SCHOOL SCHOOL VILLACIN NATIONAL HIGH SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED
INTERVIEWED

NAME OF ATHLETE SERBON, JANAH ROSE B.


117554120198 LRN 117554120181
06/15/2006 DATE OF BIRTH 01/24/2007
VILLACIN NATIONAL HIGH SCHOOL SCHOOL VILLACIN NATIONAL HIGH SCHOOL

NOTE:
PLEASE USE A4 SIZE COPY PAPER

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)


Revised as of September 26, 2019 VI - WESTREN VISAYAS
REGION
CADIZ CITY
DIVISION

BASKETBALL 3X3 - SECONDARY GIRLS


EVENT

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
athlete athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

NOTE:
PLEASE USE A4 SIZE COPY PAPER

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)


. Revised as of September 26, 2019 VI - WESTREN VISAYAS
REGION
CADIZ CITY
DIVISION

BASKETBALL 3X3 - SECONDARY GIRLS


EVENT

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
athlete athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

A. AR (ATHLETE'S RECORD)
B. ORIGINAL COPY OF PSA/NSO
C. SF 10 / FORM - 137
D. CERTIFICATE OF ATTENDANCE (for Palarong Pambansa Only)
E. PARENTAL CONSENT/AFFIDAVIT/SWORN STATEMENT OF ACTUAL CARE & CUSTODY
athlete F. MEDICAL CERTIFICATE
athlete
G. DISABILITY ASSESSMENT (for PARAGAMES Only)
INTERVIEWED

NAME OF ATHLETE
LRN
DATE OF BIRTH
SCHOOL

NOTE:
PLEASE USE A4 SIZE COPY PAPER

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

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