Athlete Record
Certificate of Enrollment
Certificate of Completion
Dental Certificate
ronie/17
with appreciation and thanks to ronie almia, cotabato city division, region 12
LARONG PAMBANSA
pletion
Medical Certificate 1
Medical Certificate 2
A B C D E F G H I J
1 REGION I - ILOCOS REGION
2 DIVISION CITY OF DAGUPAN
3 SCHOOL YEAR: 2018-2019
4
5 NAME: AQUINO CHARLIE V.
6 (Last) (First) (M.I.) New
7 CONTACT NUMBER:
8 SEX: MALE
9 LEARNER REFERENCE NUMBER (LRN) 102165090013
10 DATE OF BIRTH: (mm/dd/yyyy) 3/19/2003
11 AGE 15
12 PLACE OF BIRTH: PANTAL DIST., DAGUPAN CITY, PANGASINAN
13 SCHOOL NAME: BONUAN BUQUIG NATONAL HIGH SCHOOL SCHOOL TYPE: PUBLIC
14 SCHOOL CODE 300367
15 ADDRESS OF SCHOOL: SAN GABRIEL ST., BONUAN BUQUIG, DAGUPAN CITY
16 HOME ADDRESS:
17 PARENTS: JULIO ABARQUEZ VELERIO JELLYN V. AQUINO
18 Fathers Name Mother/Guardian
19 ADDRESS OF PARENTS:
20 GRADE LEVEL: Grade 9
21 SECTION: BLUEBIRD
22 EVENT: BASEBALL - SECONDARY
23 COACH: JAPHETH F. DELA CRUZ
24 TEACHER ADVISER: MICHELLE N. NAVARRO
25 SCHOOL HEAD/ REGISTRAR: ALFRED B. GONZALES
26 GUARDIAN:
27 RELATIONSHIP
28 DIVISION SPORTS OFFICER: SHERYL S. VILLACORTA
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AR-I (ATHLETE RECORD)
I - ILOCOS REGION
Region
CITY OF DAGUPAN
Division
Latest 1½ x 1½ picture
A. PERSONAL DATA:
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 Signature Division Sports Officer
DIVISION MEET JAPHETH F. DELA CRUZ SHERYL S. VILLACORTA
REGIONAL MEET KENNETH CARL A. LLAMAS SHERYL S. VILLACORTA
Screened by:
Date: Date:
FOR PALARONG PAMBANSA ONLY
ECORD)
icture
V.
(M.I.)
L DIST., DAGUPAN
NO
ks
ACE
fficer
me)
Republic of the Philippines
Department of Education
I - ILOCOS REGION
(Region)
CITY OF DAGUPAN
(Division)
CERTIFICATE OF ENROLMENT
Date: 10/1/2018
ALFRED B. GONZALES
Principal/School Head/Registrar
(Signature over printed name)
CITY OF DAGUPAN
(Division)
CERTIFICATE OF COMPLETION
Date:
This is to certify
that CHARLIE V. AQUINO has completed
Grade 9 (Elementary/Secondary Level) for the School Year 2018-2019 .
ALFRED B. GONZALES
Principal/School Head/Registrar
(Signature over printed name)
CITY OF DAGUPAN
(Division)
P A R E N TA L C O N S E N T
Date: 2/4/2019
I/We hereby willingly and voluntarily give consent the participation of my/our
son/daughter CHARLIE V. AQUINO in the
Division, Regional Meet and Palarong Pambansa.
I have considered the benefits that my son or daughter will derive from his/her
participation in this activity provided that due care and precautio n will be observed to
ensure the comfort and safety of my son/daughter and that DepED employees and
personnel may not be held responsible for any untoward incident that may happen
beyond their control.
Verified by :
Remarks:
CITY OF DAGUPAN
(Division)
MEDICAL CERTIFICATE
Date: 2/12/2019
age 15 sex MALE born on 3/19/2003 and have found that he/she is
physically fit, during the time of examination, to join and compete in the lower meets a
Palarong Pambansa.
Physical Examination
Date examined: _
Height Weight: Blood Pressure
Pulse, Resting Respiratory Rate
Other Remarks:
Physician/Medical Officer
(Signature over printed name)
License No.
PTR.:
Date:
CITY OF DAGUPAN
(Division)
MEDICAL CERTIFICATE
3. Have you been hit hard in the head in the last 6 weeks? YES NO YES NO
4. Have you had any headache in the last 2 week? YES NO YES NO
6. Does any disease run in your family ? Sudden unexfecte YES NO YES NO
JELLYN V. AQUINO
Name and signature (Parent)
Physician/Medical Officer
(Signature over printed name)
License No.
PTR.:
Date:
CITY OF DAGUPAN
(Division)
ABNORMALITI
MEDICAL CERTIFICATE
ES
Medical Examination following post
If Athlete had a Concussion in the
period after Concusion was normal Normal Abnormal
past year please cetify that:
Athlete Fit to Box
Name of MD________________________________________
Lic. Number:______________________
Date:______________________
DATE OF VISIT
YEAR LEVEL REMARKS TEMPORARY TEETH
DATE INDEX D.F.T.
EXAMINATION NO. T /DECAYED
SEALANT (GI) NO. T/ FILLED
PERMANENT FILLING TOTAL D.F.T.
ART
EXTRACTION PERMANENT TEETH
ORAL PROPHYLAXIS INDEX D.F.T.
REFERRAL NO. T /DECAYED
OTHER ORAL TREATMENT NO. T/MISSING
NO. T/ FILLED
TOTAL D.F.T.
TOTAL SOUND TEETH
SYMBOLS FOR MOUTH EXAMINATION SYMBOLS FOR ACCOMPLISHMENT
X - TOOTH INDICATED DU - DECUBITAL ULCER XT - EXTRACTED PERMANENT TOOTH
FOR EXTRACTION MAL - MALOCLUSSION xt - EXTRACTED TEMPORARY TOOTH
F - TOOTH INDICATED FLU - FLUOROSIS Am - AMALGAM FILLING
FOR FILLING Gn - NORMAL Com - COMPOSITE FILLING
HEAVY - TOOTH WITH TEMPORARY Gm - MODERATE GINGIVITIS
SHADE FILLING (1-2 QUADRANTS) ARTIFICIAL RESTORATION
RC - RECURRENT CARIES Gs - SEVERE GINGIVITIS JC - JACKET CROWN
RF - ROOT FRAGMENT (3-4 QUADRANTS) I - INLAY
M - MISSING TOOTH CMR - COMPLETE MOUTH REHAB OP - ORAL PROPHYLAXIS
(√) - SOUND ERUPTED PERMANENT ZOE - ZINC OXIDE UEGENOL FILLING
TOOTH TF - TEMPORARY FILLING
R - REFERRED TO PRIVATE DENTIST
UN - UNERUPTED TOOTH
Division Meet Remarks/Findings:
DENTIST
(signature over printed name)
PRC: LICENSE: Date Examined:
Regional Meet Remarks/Findings:
DENTIST
(signature over printed name)
PRC: LICENSE: Date Examined:
Palarong Pambansa Remarks/Findings:
DENTIST
(signature over printed name)
PRC: LICENSE: Date Examined:
FOR PALARONG PAMBANSA ONLY
YEAR level event gender Athletes coach
2018 ELEMENTARY ARNIS M 3 1
2018 ELEMENTARY ARNIS F 3 1
2018 ELEMENTARY ATHLETICS M 12 2
2018 ELEMENTARY ATHLETICS F 12 2
2018 ELEMENTARY BADMINTON M 4 1
2018 ELEMENTARY BADMINTON F 4 1
2018 ELEMENTARY BASEBALL M 12 1
2018 ELEMENTARY BASKETBALL M 12 1
2018 ELEMENTARY CHESS M 2 1
2018 ELEMENTARY CHESS F 2 1
2018 ELEMENTARY FOOTBALL M 18 1
2018 ELEMENTARY GYMNASTICS (MAG) M 3 1
2018 ELEMENTARY GYMNASTICS (RG) F 3 1
2018 ELEMENTARY GYMNASTICS (WAG) F 3 1
2018 ELEMENTARY SEPAK TAKRAW M 4 1
2018 ELEMENTARY SOFTBALL F 12 1
2018 ELEMENTARY SWIMMING M 10 1
2018 ELEMENTARY SWIMMING F 10 1
2018 ELEMENTARY TABLE TENNIS M 4 1
2018 ELEMENTARY TABLE TENNIS F 4 1
2018 ELEMENTARY TAEKWONDO M 6 1
2018 ELEMENTARY TAEKWONDO F 6 1
2018 ELEMENTARY TENNIS M 4 1
2018 ELEMENTARY TENNIS F 4 1
2018 ELEMENTARY VOLLEYBALL M 12 1
2018 ELEMENTARY VOLLEYBALL F 12 1
2018 SECONDARY ARCHERY M 4 1
2018 SECONDARY ARCHERY F 4 1
2018 SECONDARY ARNIS M 5 1
2018 SECONDARY ARNIS F 5 1
2018 SECONDARY ATHLETICS M 15 2
2018 SECONDARY ATHLETICS F 15 2
2018 SECONDARY BADMINTON M 4 1
2018 SECONDARY BADMINTON F 4 1
2018 SECONDARY BASEBALL M 12 1
2018 SECONDARY BASKETBALL M 12 1
2018 SECONDARY BASKETBALL F 12 1
2018 SECONDARY BASKETBALL 3X3 M 4 1
2018 SECONDARY BASKETBALL 3X3 F 4 1
2018 SECONDARY BILLIARDS M 2 1
2018 SECONDARY BILLIARDS F 2 1
2018 SECONDARY BOXING M 10 1
2018 SECONDARY CHESS M 2 1
2018 SECONDARY CHESS F 2 1
2018 SECONDARY FOOTBALL F 18 1
2018 SECONDARY FUTSAL F 12 1
2018 SECONDARY GYMNASTICS (MAG) M 3 1
2018 SECONDARY GYMNASTICS (RG) F 3 1
2018 SECONDARY GYMNASTICS (WAG) F 3 1
2018 SECONDARY SEPAK TAKRAW M 12 1
2018 SECONDARY SEPAK TAKRAW F 5 1
2018 SECONDARY SOFTBALL F 12 1
2018 SECONDARY SWIMMING M 10 1
2018 SECONDARY SWIMMING F 10 1
2018 SECONDARY TABLE TENNIS M 4 1
2018 SECONDARY TABLE TENNIS F 4 1
2018 SECONDARY TAEKWONDO M 10 1
2018 SECONDARY TAEKWONDO F 10 1
2018 SECONDARY TENNIS M 4 1
2018 SECONDARY TENNIS F 4 1
2018 SECONDARY VOLLEYBALL M 12 1
2018 SECONDARY VOLLEYBALL F 12 1
2018 SECONDARY WRESTLING M 8 1
2018 SECONDARY WRESTLING F 8 1
2018 SECONDARY WUSHU M 6 1
2018 SECONDARY WUSHU F 4 1
2018 DEMO SPORTS AEROBIC GYMNASTICS - ELEMENTARY M/F 4 1
2018 DEMO SPORTS AEROBIC GYMNASTICS - SECONDARY M/F 4 1
2018 DEMO SPORTS DANCESPORTS - ELEMENTARY (LATIN) M 1
2019 DEMO SPORTS DANCESPORTS - ELEMENTARY (LATIN) F 1
2018 DEMO SPORTS DANCESPORTS - ELEMENTARY (STANDARD) M 1
2019 DEMO SPORTS DANCESPORTS - ELEMENTARY (STANDARD) F 1
2018 DEMO SPORTS DANCESPORTS - SECONDARY (LATIN) M 1 1
2018 DEMO SPORTS DANCESPORTS - SECONDARY (LATIN) F 1
2018 DEMO SPORTS DANCESPORTS - SECONDARY (STANDARD) M 1
2018 DEMO SPORTS DANCESPORTS - SECONDARY (STANDARD) F 1
2018 DEMO SPORTS PENCAK SILAT - SECONDARY BOYS M 5 1
2019 DEMO SPORTS PENCAK SILAT - SECONDARY GIRLS F 5
2018 PARAGAMES ATHLETICS V.I. M 3 3
2018 PARAGAMES ATHLETICS V.I. F 3
2018 PARAGAMES ATHLETICS I.D. M 10 2
2018 PARAGAMES ATHLETICS I.D. F 10 2
2018 PARAGAMES ATHLETICS/SWIMMING O.H. M 2 2
2018 PARAGAMES ATHLETICS/SWIMMING O.H. F 2
2018 PARAGAMES SMIMMING I.D. M 2 2
2018 PARAGAMES SMIMMING I.D. F 2
2018 PARAGAMES BOCCE I.D. M 2 1
2018 PARAGAMES BOCCE I.D. F 2
2018 PARAGAMES GOALBALL V.I. M 2 1
2018 PARAGAMES GOALBALL V.I. F 2
Asst.Coach Chaperon Total category
4 B Reference:
1 5 G (Enclosure No.3 to Palarong Pambansa Memorandumn No. 5 s. 2018)
14 B REGULAR DEMO
1 15 G ELEM SEC ELEM
1 6 B ATHLETES 181 292 8
1 1 7 G COACHES 28 42 1
1 14 B ASST. COACHES 6 7
13 B CHAPERONS 11 19
3 B 226 360 9
1 4 G
19 B
4 B
1 5 G
4 G
5 B
1 1 15 G
11 B REFERENCE
1 12 G DM 026 s. 2018
5 B DM 029 s. 2018
1 6 G DM 049 s. 2018
7 B DM 064 s. 2018
1 8 G
5 B
1 6 G
1 14 B
1 1 15 G
5 B
1 6 G
6 B
1 7 G
17 B
1 18 G
1 6 B
1 1 7 G
1 14 B
13 B
1 14 G
5 B
1 6 B
3 B
1 4 G
1 12 B
3 B
1 4 G
19 G
1 14 G
4 B
1 5 G
4 G
13 B
1 7 G
1 1 15 G
11 B
1 12 G
5 B
1 6 G
11 B
1 12 G
5 B
1 6 G
1 14 B
1 1 15 G
9 B
1 10 G
7 B
1 6 G
5 B/G
5 B/G
1 B
1 G
1 B
1 G
1 3 B
1 G
1 B
1 G
6 B
1 6 G
6 B
3 G
12 B
12 G
4 B
2 G
4 B
2 G
3 B
2 G
3B
2G
673
n No. 5 s. 2018)
PARAGAMES
SEC
18 42
3 13
2
23 55
Ilocos NortBatanes Aurora Camarines Aklan Bohol Biliran ZamboangaBukidnon
Ilocos Sur Cagayan Bataan Camarines Antique Cebu Leyte ZamboangaCamiguin
La Union Isabela Bulacan Catanduan Capiz Cebu City Southern L ZamboangaLanao del
PangasinanNueva Vizc Nueva Ecij Masbate Guimaras DumagueteEastern Sa Dapitan CitMisamis Oc
PangasinanQuirino Pampanga Sorsogon Iloilo Lapu-Lapu Northern Dipolog CitMisamis Or
Dagupan CiTuguegaraoTarlac Iriga City Negros OccMandaue CSamar (WesIsabela Cit Cagayan de
Laoag City Cauayan CiZambales Legaspi Cit Bacolod Ci Negros Ori Calbayog C Pagadian C Gingoog Ci
San Carlos Santiago CiAngeles CitNaga City Bago City Siquijor Ormoc CityZamboangaIligan City
Urdaneta CCity of Ilag CabanatuanSorsogon CCadiz City Toledo CityTacloban City Ozamis Cit
Candon City Olongapo CTabaco Cit Iloilo City Bayawan CiMaasin City Oroquieta
Alaminos City San Jose d Ligao City La Carlota Danao City Catbalogan City Tangub City
Vigan City San FernanMasbate CiRoxas City Tagbilaran Borongan City Valencia City
San Fernando City Gapan City Sagay City Talisay City Baybay City Malaybalay City
Batac City Tarlac City San Carlos Tanjay City El Salvador
Munoz Science City Silay City Bais City
Balanga City KabankalanGuihulngan City
Malolos City Passi City Carcar City
San Jose City Escalante CBogo City
Mabalacat City City of Naga, Cebu
Meycauayan City
CompostelaNorth CotaAgusan delBasilan Abra Manila Batangas Marinduque
Davao del Sarangani Agusan delLanao del SApayao Quezon CitCavite Occidental Mindoro
Davao del South CotaButuan Cit Lanao del SBenguet Pasay City Laguna Oriental Mindoro
Davao OrieSultan Kud Siargao MaguindanIfugao Caloocan CQuezon Palawan
Davao City Cotabato CSurigao Cit Sulu I Kalinga Mandaluyon Rizal Romblon
Digos City General SanSurigao delTawi-Tawi Mt. Provin Marikina CiBatangas C Puerto Princesa City
Panabo Cit Kidapawan Surigao delMarawi Cit Baguio CityMakati CityCavite City Calapan City
Tagum CityKoronadal Bislig City Sulu II Tabuk City Pasig City Lipa City
Island GardTacurong CDinagat Isl Shariff Kabunsuan Paranaque Lucena City
Mati City Bayugan Ci Lamitan City Las Piñas C San Pablo City
Tangub City CabadbaranLanao del Sur - IB Valenzuela Calamba City
Valencia City Lanao del Sur - IIB Malabon CiAntipolo City
Malaybalay City Maguindanao II Taguig Tanauan City
El Salvador MuntinlupaSta. Rosa City
City of San Dasmarinas City
Navotas Tayabas City
Bacoor City
Imus City
Level ELEMENTARY SECONDARY PARAGAMES
ELEMENTARY ARNIS ARCHERY ATHLETICS V.I.
SECONDARY ATHLETICS ARNIS ATHLETICS I.D.
PARAGAMES BADMINTON ATHLETICS ATHLETICS/SWIMMING O.
DEMO SPORTS BASEBALL BADMINTON SMIMMING I.D.
BASKETBALL BASEBALL BOCCE I.D.
CHESS BASKETBALL GOALBALL V.I.
FOOTBALL BASKETBALL 3x3
GYMNASTICS (MAG) BILLIARDS
GYMNASTICS (RG) BOXING
GYMNASTICS (WAG) CHESS
SEPAK TAKRAW JR. FOOTBALL
SOFTBALL FUTSAL
SWIMMING GYMNASTICS (MAG)
TABLE TENNIS GYMNASTICS (RG)
TAEKWONDO GYMNASTICS (WAG)
TENNIS SEPAK TAKRAW
VOLLEYBALL SOFTBALL
BOXING SWIMMING
TABLE TENNIS
TAEKWONDO
TENNIS
VOLLEYBALL
WRESTLING
WUSHU
DEMO SPORTS CLASS SEX SCHOOL TYPE
AEROBIC GYMNASTICS - ELEMENTARY B MALE PUBLIC
AEROBIC GYMNASTICS - SECONDARY G FEMALE PRIVATE
DANCE SPORTS - ELEMENTARY (LATIN) B/G B/G
DANCE SPORTS - ELEMENTARY (STANDARD)
DANCE SPORTS - SECONDARY (LATIN)
DANCE SPORTS - SECONDARY (STANDARD)
PENCAK SILAT - SECONDARY BOYS
PENCAK SILAT - SECONDARY GIRLS
male athletes
ELEMENTARY
SECONDARY