Revised as of FEBRUARY 8, 2024 NEGROS ISLAND REGION
REGION
SAGAY CITY
DIVISION
SWIMMING SECONDARY BOYS
EVENT
A. COACH/ASST. COACH RECORD
B. APPOINTMENT/EMPLOYMENT/CONTRACT OF SERVICE
C. OMNIBUS AFFIDAVIT
D. MEDICAL CERTIFICATE
Coach E CERTIFICATE OF TRAINING
Assistant Coach
F CERTIFICATE OF SPORTS MEMBERSHIP/ LICENSE OR CERTIFICATIONS/
ACCREDITATION
NAME
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
BACRUYA, RAMEL D. NAME OF ATHLETE BONILLA, LOUI JOHN S.
11770346009 LRN 117698130029
SAGAY CITY DATE OF BIRTH SAGAY CITY
SAGAY CITY SENIOR HIGH SCHOOL SCHOOL SAGAY CITY SENIOR 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
LRN
DATE OF BIRTH
SCHOOL
NOTE:
PLEASE USE A4 SIZE COPY PAPER
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
