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A. PERSONAL DATA:
Name:
Sex:
(Last)
(First)
Age:
(M.I.)
Place of Birth:
Home Address:
Parents:
Fathers Name
Mother/Guardian
Address of Parents:
Remarks
Athlete's Signature
C. Athlete's Participation
This is to certify that based on our knowledge the above-mentioned athlete has participated
in the lower meets.
Athletic meet
Coaches
Screened by:
Division Meet
Regional Meet
Date:
Date: