Revised July 2019

AR-I (ATHLETE RECORD)

Region

Latest 1½ x 1½ picture
Division

A. PERSONAL DATA:

Name:
(Last) (First) (M.I.)

Sex: Learner Reference Number (LRN) Contact Number

Date of Birth: (mm/dd/yyyy) Age: Place of Birth:

School: Grade Level
Address of School:
Present Address:
Parents:
Fathers Name Mother/Guardian
Address of Parents:

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 Local/International Competition (For the Current School Year)

Inclusive Dates Sports Event Athletic Meet Remarks

(Use separate sheet if necessary)

Athlete 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 Name and Signature of

Division/Regional Meet Name and Signature of Coach
Division 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)