AR-I (ATHLETE RECORD)

REGION III
Region

OLONGAPO CITY
Division

Latest 1 x 1 picture

A. PERSONAL DATA:
Name:

CHIA

FRANCES JAMIE

(First)

(M.I.)

(Last)

FEMALE Learner Reference Number (LRN)

Sex:

Date of Birth: (mm/dd/yy)

School:
Address of School:
Home Address:

Place of
Birth:

Age:
REGIONAL SCIENCE HIGH SCHOOL

Contact Number:

BEIS (Private School Number )

Parents:
Fathers Name

Mother/Guardian

Address of Parents:
B. Athlete's Participation in Local/International Competition
Inclusive Dates

Sports Event

Athletic Meet

Remarks

(Use separate sheet if necessary)

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

Name of Coach

Division PESS Supervisor/s

Signature

Division/Provincial Meet
Regional Meet
Palarong Pambansa
(Use separate sheet if necessary)

Screened by:
Division Meet

Regional Meet

(Signature over Printed Name)

Date:
FOR PALARONG PAMBANSA ONLY

(Signature over Printed Name)

Date: