Revised as of September 26, 2019

AR (ATHLETE RECORD)
1
Region

SCHOOLS DIVISION OFFICE 1 PANGASINAN

Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: TAMONDONG ALEXANDRIA LINE L.

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

Sex: FEMALE Learner Reference Number (LRN) 400153180018 Contact Number 09453753417
Date of Birth:
(mm/dd/yyyy) 04/18/2013 Age: 9 Place of Birth: BUGALLON, PANGASINAN
School: SALOMAGUE SUR ELEMENTARY SCHOOL Grade Level FIVE
Address of School: SALOMAGUE SUR, BUGALLON, PANGASINAN
Present Address: SALOMAGUE SUR, BUGALLON, PANGASINAN
Parents: ALEXANDER D. TAMONDONG LIEZEL L. TAMONDONG
Fathers Name Mother/Guardian
Address of Parents/Guardian: SALOMAGUE SUR, BUGALLON, PANGASINAN

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 the Lower Meets (For the Current School Year)
Inclusive Dates Sports Event Athletic Meet Remarks
FEBRUARY 25, 2023 TAEKWONDO GIRLS MUNICIPAL ATHLETIC MEET GOLD
MARCH 3-5, 2023 TAEKWONDO GIRLS SDO1 PANGASINAN ATHLETIC ASSOCIATION MEET

(Use separate sheet if necessary)

ALEXANDRIA LINE L. TAMONDONG

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 Sports Name and Signature of

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

MUNICIPAL INTER-SCHOOL SPORTS MARILYN P. CUISON Dulce D. Tolosa, EdD

CLUB COMPETITION

SDO 1 PANGASINAN ATHLETIC MARILYN P. CUISON Dulce D. Tolosa, EdD

ASSOCIATION (SDO1P-AA) MEET

(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 as of September 26, 2019

AR (ATHLETE RECORD)
1
Region

SCHOOLS DIVISION OFFICE 1 PANGASINAN

Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: NAVARRO JENICA PAULA G.

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

Sex: FEMALE Learner Reference Number (LRN) 101397170037 Contact Number 09453753417
Date of Birth:
(mm/dd/yyyy) 01-15-2012 Age: 11 Place of Birth: BUGALLON, PANGASINAN
School: SALOMAGUE SUR ELEMENTARY SCHOOL Grade Level FIVE
Address of School: SALOMAGUE SUR, BUGALLON, PANGASINAN
Present Address: SALOMAGUE SUR, BUGALLON, PANGASINAN
Parents: JESUS A. NAVARRO MARIVIC G. NAVARRO
Fathers Name Mother/Guardian
Address of Parents/Guardian: SALOMAGUE SUR, BUGALLON, PANGASINAN

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 the Lower Meets (For the Current School Year)
Inclusive Dates Sports Event Athletic Meet Remarks
FEBRUARY 25, 2023 TABLE TENNIS GIRLS MUNICIPAL ATHLETIC MEET GOLD
MARCH 3-5, 2023 TABLE TENNIS GIRLS SDO1 PANGASINAN ATHLETIC ASSOCIATION MEET

(Use separate sheet if necessary)

JENICA PAULA G. NAVARRO

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 Sports Name and Signature of

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

MUNICIPAL INTER-SCHOOL SPORTS MARILYN P. CUISON Dulce D. Tolosa, EdD

CLUB COMPETITION

SDO 1 PANGASINAN ATHLETIC MARILYN P. CUISON Dulce D. Tolosa, EdD

ASSOCIATION (SDO1P-AA) MEET

(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 as of September 26, 2019

AR (ATHLETE RECORD)
1
Region

SCHOOLS DIVISION OFFICE 1 PANGASINAN

Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: ZUÑIGA JOHN MICHAEL V.

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

Sex: MALE Learner Reference Number (LRN) 101397160008 Contact Number 09453753417
Date of Birth:
(mm/dd/yyyy) 01-10-2011 Age: 12 Place of Birth: BUGALLON, PANGASINAN
School: SALOMAGUE SUR ELEMENTARY SCHOOL Grade Level SIX
Address of School: SALOMAGUE SUR, BUGALLON, PANGASINAN
Present Address: SALOMAGUE SUR, BUGALLON, PANGASINAN
Parents: RODNIE S. ZUÑIGA DELLIA LYN V. ZUÑIGA
Fathers Name Mother/Guardian
Address of Parents/Guardian: SALOMAGUE SUR, BUGALLON, PANGASINAN

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 the Lower Meets (For the Current School Year)
Inclusive Dates Sports Event Athletic Meet Remarks
FEBRUARY 25, 2023 ATHLETICS BOYS MUNICIPAL ATHLETIC MEET GOLD
MARCH 3-5, 2023 ATHLETICS BOYS SDO1 PANGASINAN ATHLETIC ASSOCIATION MEET

(Use separate sheet if necessary)

JOHN MICHAEL V. ZUÑIGA

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 Sports Name and Signature of

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

MUNICIPAL INTER-SCHOOL SPORTS FRANKLIN C. CUISON Dulce D. Tolosa, EdD

CLUB COMPETITION

SDO 1 PANGASINAN ATHLETIC FRANKLIN C. CUISON Dulce D. Tolosa, EdD

ASSOCIATION (SDO1P-AA) MEET

(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 as of September 26, 2019

AR (ATHLETE RECORD)
1
Region

SCHOOLS DIVISION OFFICE 1 PANGASINAN

Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: RAMOS KAYLEEN DARAH DC.

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

Sex: FEMALE Learner Reference Number (LRN) 101396160035 Contact Number 09453753417
Date of Birth:
(mm/dd/yyyy) 08-26-2011 Age: 11 Place of Birth: BUGALLON, PANGASINAN
School: SALOMAGUE SUR ELEMENTARY SCHOOL Grade Level SIX
Address of School: SALOMAGUE SUR, BUGALLON, PANGASINAN
Present Address: SALOMAGUE SUR, BUGALLON, PANGASINAN
Parents: CEZAR E. RAMOS, JR. MARIBEL DC. RAMOS
Fathers Name Mother/Guardian
Address of Parents/Guardian: SALOMAGUE SUR, BUGALLON, PANGASINAN

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 the Lower Meets (For the Current School Year)
Inclusive Dates Sports Event Athletic Meet Remarks
FEBRUARY 25, 2023 TABLE TENNIS GIRLS MUNICIPAL ATHLETIC MEET GOLD
MARCH 3-5, 2023 TABLE TENNIS GIRLS SDO1 PANGASINAN ATHLETIC ASSOCIATION MEET

(Use separate sheet if necessary)

KAYLEEN DARAH DC. RAMOS

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 Sports Name and Signature of

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

MUNICIPAL INTER-SCHOOL SPORTS MARILYN P. CUISON Dulce D. Tolosa, EdD

CLUB COMPETITION

SDO 1 PANGASINAN ATHLETIC MARILYN P. CUISON Dulce D. Tolosa, EdD

ASSOCIATION (SDO1P-AA) MEET

(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 as of September 26, 2019

AR (ATHLETE RECORD)
1
Region

SCHOOLS DIVISION OFFICE 1 PANGASINAN

Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: DIMAUNAHAN RINETH G.

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

Sex: FEMALE Learner Reference Number (LRN) 101397160014 Contact Number 09453753417
Date of Birth:
(mm/dd/yyyy) 04-16-2011 Age: 11 Place of Birth: BUGALLON, PANGASINAN
School: SALOMAGUE SUR ELEMENTARY SCHOOL Grade Level SIX
Address of School: SALOMAGUE SUR, BUGALLON, PANGASINAN
Present Address: SALOMAGUE SUR, BUGALLON, PANGASINAN
Parents: RODRIGO C. DIMAUNAHAN JANET G. DIMAUNAHAN
Fathers Name Mother/Guardian
Address of Parents/Guardian: SALOMAGUE SUR, BUGALLON, PANGASINAN

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 the Lower Meets (For the Current School Year)
Inclusive Dates Sports Event Athletic Meet Remarks
FEBRUARY 25, 2023 TABLE TENNIS GIRLS MUNICIPAL ATHLETIC MEET GOLD
MARCH 3-5, 2023 TABLE TENNIS GIRLS SDO1 PANGASINAN ATHLETIC ASSOCIATION MEET

(Use separate sheet if necessary)

RINETH G. DIMAUNAHAN
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 Sports Name and Signature of

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

MUNICIPAL INTER-SCHOOL SPORTS FRANKLIN C. CUISON Dulce D. Tolosa, EdD

CLUB COMPETITION

SDO 1 PANGASINAN ATHLETIC FRANKLIN C. CUISON Dulce D. Tolosa, EdD

ASSOCIATION (SDO1P-AA) MEET

(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 as of September 26, 2019

AR (ATHLETE RECORD)
1
Region

SCHOOLS DIVISION OFFICE 1 PANGASINAN

Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: VELASCO ANNALYN S.

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

Sex: FEMALE Learner Reference Number (LRN) 101397170069 Contact Number 09453753417

Date of Birth: (mm/dd/yyyy) 09/17/2011 Age: 11 Place of Birth: BUGALLON, PANGASINAN

School: SALOMAGUE SUR ELEMENTARY SCHOOL Grade Level FIVE
Address of School: SALOMAGUE SUR, BUGALLON, PANGASINAN
Present Address: SALOMAGUE SUR, BUGALLON, PANGASINAN
Parents: ALFREDO Q. VELASCO JACQUILYN S. VELASCO
Fathers Name Mother/Guardian
Address of Parents/Guardian: SALOMAGUE SUR, BUGALLON, PANGASINAN

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 the Lower Meets (For the Current School Year)
Inclusive Dates Sports Event Athletic Meet Remarks
FEBRUARY 25, 2023 ATHLETICS GIRLS MUNICIPAL ATHLETIC MEET GOLD
MARCH 3-5, 2023 ATHLETICS GIRLS SDO1 PANGASINAN ATHLETIC ASSOCIATION MEET

(Use separate sheet if necessary)

ANNALYN S. VELASCO
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 Sports Name and Signature of

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

MUNICIPAL INTER-SCHOOL SPORTS CLUB FRANKLIN C. CUISON Dulce D. Tolosa, EdD

COMPETITION

SDO 1 PANGASINAN ATHLETIC FRANKLIN C. CUISON Dulce D. Tolosa, EdD

ASSOCIATION (SDO1P-AA) MEET

(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 as of September 26, 2019

AR (ATHLETE RECORD)
1
Region

SCHOOLS DIVISION OFFICE 1 PANGASINAN

Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: DELA VEDA JUNIOR O.

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

Sex: MALE Learner Reference Number (LRN) 101589160001 Contact Number 09453753417
Date of Birth: (mm/dd/yyyy) 01-06-2011 Age: 11 Place of Birth: BUGALLON, PANGASINAN
School: SALOMAGUE SUR ELEMENTARY SCHOOL Grade Level SIX
Address of School: SALOMAGUE SUR, BUGALLON, PANGASINAN
Present Address: SALOMAGUE SUR, BUGALLON, PANGASINAN
Parents: GABRIEL C. DELA VEDA MARIBEL O. DELA VEDA
Fathers Name Mother/Guardian
Address of Parents/Guardian: SALOMAGUE SUR, BUGALLON, PANGASINAN

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 the Lower Meets (For the Current School Year)
Inclusive Dates Sports Event Athletic Meet Remarks
FEBRUARY 25, 2023 ATHLETICS BOYS MUNICIPAL ATHLETIC MEET SILVER
MARCH 3-5, 2023 ATHLETICS BOYS SDO1 PANGASINAN ATHLETIC ASSOCIATION MEET

(Use separate sheet if necessary)

JUNIOR O. DELA VEDA

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 Sports Name and Signature of

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

MUNICIPAL INTER-SCHOOL SPORTS CLUB FRANKLIN C. CUISON Dulce D. Tolosa, EdD

COMPETITION

SDO 1 PANGASINAN ATHLETIC FRANKLIN C. CUISON Dulce D. Tolosa, EdD

ASSOCIATION (SDO1P-AA) MEET

(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 as of September 26, 2019

AR (ATHLETE RECORD)
1
Region

SCHOOLS DIVISION OFFICE 1 PANGASINAN

Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name: IDOS BENZ LOUIE M.

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

Sex: MALE Learner Reference Number (LRN) 101159160005 Contact Number 09453753417
Date of Birth: (mm/dd/yyyy) 03/27/2011 Age: 11 Place of Birth: BUGALLON, PANGASINAN
School: SALOMAGUE SUR ELEMENTARY SCHOOL Grade Level SIX
Address of School: SALOMAGUE SUR, BUGALLON, PANGASINAN
Present Address: SALOMAGUE SUR, BUGALLON, PANGASINAN
Parents: BENSON O. IDOS LOUDIELY M. IDOS
Fathers Name Mother/Guardian
Address of Parents/Guardian: SALOMAGUE SUR, BUGALLON, PANGASINAN

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 the Lower Meets (For the Current School Year)
Inclusive Dates Sports Event Athletic Meet Remarks
FEBRUARY 25, 2023 ATHLETICS BOYS MUNICIPAL ATHLETIC MEET GOLD
MARCH 3-5, 2023 ATHLETICS BOYS SDO1 PANGASINAN ATHLETIC ASSOCIATION MEET

(Use separate sheet if necessary)

BENZ LOUIE M. IDOS

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 Sports Name and Signature of

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

MUNICIPAL INTER-SCHOOL SPORTS CLUB FRANKLIN C. CUISON Dulce D. Tolosa, EdD

COMPETITION

SDO 1 PANGASINAN ATHLETIC FRANKLIN C. CUISON Dulce D. Tolosa, EdD

ASSOCIATION (SDO1P-AA) MEET

(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)