Revised as of April 3, 2023
AR (ATHLETE RECORD)
III
Region
NUEVA ECIJA
Latest 1½ x 1½ picture
Division
A. PERSONAL DATA:
Name: JAVIER JHUSTINE J.
(Last) (First) (M.I.)
Sex: MALE Learner Reference Number (LRN) 105773160006 Contact Number 9382287953
Date of Birth: (mm/dd/yyyy) 02/21/2011 Age: 12 Place of Birth: STO. ROSARIO, STO. DOMINGO, NUEVA ECIJA
School: COMITANG ELEMENTARY SCHOOL Grade Level SIX
Address of School: COMITANG, STO. DOMINGO, NUEVA ECIJA ======
ID#AAAAreRaM6Y
Present Address: ZONE 1, COMITANG, STO. DOMINGO, NUEVA ECIJA Place of Birth (2023-03-22 13:07:25
Indicate the Municipality/Province/City
Parents: ROMMEL A. JAVIER JOYCEE J. JAVIER
Fathers Name Mother/Guardian
Address of Parents/Guardian: ZONE 1, COMITANG, STO. DOMINGO, NUEVA ECIJA
B. Participation in the previous Palarong Pambansa. Yes ____ No _____ . If Yes, kindly fill up the table below
Year of Participation Sports Event Venue Remarks
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ID#AAAAreRaM6Q
Remarks (2023-03-22
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Gold, Silver. Bronze, Run
ID#AAAAreRaM6k
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Remarks (2023-03-22
ID#AAAAreRaM6E
C. Athlete's Participation in the Lower Meets (For the Current School Year) Gold, Silver. Bronze, Run
Remarks (2023-03-22
Gold, Silver. Bronze, Run
Inclusive Dates Sports Event Athletic Meet Remarks
NOVEMBER 18, 2023 ATHLETICS-100M DASH DISTRICT ATHLETIC MEET GOLD
DECEMBER 09, 2023 ATHLETICS-100M DASH TRIANGULAR ATHLETIC MEET GOLD
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ID#AAAAreRaM6g
======
Remarks (2023-03-22
ID#AAAAreRaM6U
======
Gold, Silver. Bronze, Run
Remarks (2023-03-22
ID#AAAAreRaM6M
======
Gold, Silver. Bronze, Run
(Use separate sheet if necessary) Remarks (2023-03-22
ID#AAAAreRaM6I
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Gold, Silver. Bronze, Run
Remarks (2023-03-22
JHUSTINE J. JAVIER ID#AAAAreRaM6c
Gold, Silver. Bronze, Run
Remarks (2023-03-22
Athlete's Signature over Printed Name
Gold, Silver. Bronze, Run
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 Division Name and Signature of
Meet Name and Signature of Coach
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)
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ID#AAAAreRaM6Y
Place of Birth (2023-03-22 13:07:25)
Indicate the Municipality/Province/City
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ID#AAAAreRaM6Q
Remarks (2023-03-22 13:07:25)
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Gold, Silver. Bronze, Runner-Up
ID#AAAAreRaM6k
======
Remarks (2023-03-22 13:07:25)
ID#AAAAreRaM6E
Gold, Silver. Bronze, Runner-Up
Remarks (2023-03-22 13:07:25)
Gold, Silver. Bronze, Runner-Up
======
ID#AAAAreRaM6g
======
Remarks (2023-03-22 13:07:25)
ID#AAAAreRaM6U
======
Gold, Silver. Bronze, Runner-Up
Remarks (2023-03-22
ID#AAAAreRaM6M 13:07:25)
======
Gold, Silver. Bronze, Runner-Up
Remarks (2023-03-22
ID#AAAAreRaM6I 13:07:25)
======
Gold, Silver.(2023-03-22
Bronze, Runner-Up
Remarks
ID#AAAAreRaM6c 13:07:25)
Gold, Silver.(2023-03-22
Remarks Bronze, Runner-Up
13:07:25)
Gold, Silver. Bronze, Runner-Up
