PASCUA, KARL KENT L. KARL KENT L.

PASCUA 09088812887
last name first name middle full name A CONTACT NUMBER

MAY 9, 2005 PASCUA, KARL KENT L. BADMINTON

Birthday full name B EVENT

Manila Doctors Hospital, 667 United Nations Avenue, Manila JOSEPHINE I. ORTEGA ISABELO O. LAXINA III
Birthplace class adviser COACH

Poblacion, Libacao, Aklan JUNE 11, 2012 11

ADDRESS firtst day in school(F-137) AGE

114786120067 114786 JADE R. RUIZ MALE

LRN SCHOOL ID SCHOOL HEAD athletes SEX

JANUARY 5, 2017 Principal III 2016-2017

DATE CREDENTIALS PREPARED SCHOOL POSITION SCHOOL YEAR CERT OF
ENROLMENT

LIBACAO CENTRAL ELEMENTARY SCHOOL 2016-2017

INTERMEDIATE SCHOOL SCHOOL YEAR

LIBACAO NATIONAL FORESTRY & VOCATIONAL HIGH SCHOOL ANTHONY C. PASCUA OVERSEAS FILIPINO WORKER
SCHOOL FATHERS NAME OCCUPATION

Rizal Street, Poblacion, Libacao, Aklan JENNETTE L. PASCUA

SCHOOL ADDRESS MOTHERS NAME OCCUPATION

District of Libacao FIVE

DISTRICT CERT OF COMPLETION LINK

LIBACAO
DISTRICT

INCLUSIVE DATE AR 1 NOTE

School Intamural AUGUST 4-6, 2016
Cluster Meet AUGUST 23, 2016
ALL YOU HAVE TO DO NOW IS TO ENCODE FROM
District Meet SEPTEMBER 9-10, 2016 THIS SHEET AND IT WILL MAKE YOUR WORK A LOT
Unit Meet OCTOBER 14-16, 2016 EASIER. HAVE A
NICE DAY AND GOODLUCK ON YOUR ENDEAVOR!
Division/Provincial Meet OCTOBER 27-29, 2016
Regional Meet FEBRUARY 5-11, 2017
GRADE 6 2012-2013 DIVISION DENTIST
GRADE 7 2013-2014 LUZVIMINDA R. ISAGAN
GRADE 8 2014-2015 14584
GRADE 9 2015-2016
GRADE 10 2016-2017
GRADE 11 2017-2018
GRADE 12 2017-2018
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 AR-1 (ATHLETE RECORD)

REGION VI - WESTERN VISAYAS

Region

AKLAN Latest 1½ x 1½ picture

Division

A. PERSONAL DATA:
Name: RABAL JARED SCOTT E Sex: MALE
(Last) (First) (M.I.)

Date of Birth: August 29,2000 Age: 17 Place of Birth: PHO-Dr. Rafael D. Tumbukon Mun, Hosp. Kalibo,Aklan
School: ALFONSO XII NATIONAL HIGH SCHOOL Learner Reference Number (LRN) 115526060021
Address of School: Alfonso XII, Libacao,Aklan School ID No.: 310617
Home Address: Alfonso XII,Libacao,Aklan Contact Number: 9304773280
Parents: SOCRATES P. RABAL FERIS E.RABAL
Fathers Name Mother/Guardian
Address of Parents: Alfonso XII,Libacao,Aklan

Inclusive Dates Sports Event Athletic Meet Remarks

JULY 26-28,2017
SEPTEMBER 14-15,2017
OCTOBER 4-6,2017
NOVEMBER 2-6,2017
(Use separate sheet if necessary)
CHESS-Secondary/ B School Intamural GOLD
CHESS-Secondary/ B District Meet GOLD
CHESS-Secondary/ B Unit Meet GOLD
CHESS-Secondary/ B Division/Provincial Meet
CHESS-Secondary/ B Regional Meet
CHESS-Secondary/ B Palarong Pambansa

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 PESS Supervisor/s
School Intamural JUNA B. CEREZO JENNY BIE ZAULDA
District Meet JUNA B. CEREZO JENNY BIE ZAULDA
Unit Meet CHRISTY Z. ZAMORA RUEL Z. MIA II
Division/Provincial Meet RAFAEL P. BIROL
Regional Meet
Palarong Pambansa
(Use separate sheet if necessary)

Screened by:
Unit Meet Provincial Meet

(Signature over Printed Name) (Signature over Printed Name)

Date: Date:
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FOR PALARONG PAMBANSA ONLY
 Republic of the Philippines
Department of Education
Region VI – Western Visayas
(Region)
Aklan
(Division)
ALFONSO XII NATIONAL HIGH SCHOOL
(School)
Alfonso XII, Libacao, Aklan
(School Address)

SEPTEMBER 15,2017
Date

P A R E N TA L C O N S E N T

I / We hereby willingly and voluntarily give consent the participation of

my/our son/daughter JARED SCOTT E. RABAL

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 precaution 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.

Signature of Father Signature of Mother

SOCRATES P. RABAL FERIS E. RABAL

Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with the Athlete)

Verified by:

ALADINO C. ZAULDA,JR.
School Head

REMARKS: Mother is deceased

IOL3RD
 Republic of the Philippines
Department of Education
Region VI – Western Visayas
(Region)
Aklan
(Division)
ALFONSO XII NATIONAL HIGH SCHOOL
(School)
Alfonso XII,Libacao,Aklan
(School Address)

MEDICAL CERTIFICATE

Date

To Whom it May Concern:

This is to certify that I have personally examined JARED SCOTT E. RABAL

Name
age 17 sex MALE born AUGUST 29,2000 and have found that he / she is
physically fit, during the time of examination, to join and compete in the lower meets and
Palarong Pambansa.

Event: CHESS

Physical Examination
Date Examined:

Height: Weight: Blood Preasure

Pulse Resting Respiratory Rate
Other Remarks:

Physician/Medical Officer
(Signature over printed name)
License No.
PTR:
Date:
IOL3RD
 Republic of the Philippines
DEPARTMENT OF EDUCATION
VI - WESTERN VISAYAS
Region
AKLAN
Division

DENTAL HEALTH RECORD

Latest 1½ x 1½ picture
Name: JARED SCOTT E. RABAL
Date
Age: 17 Sex MALE Birth Date AUGUST 29,2000
Event: CHESS-Secondary/ B
Parent/Guardian: SOCRATES P. RABAL
Coach:
CONDITION AND TREATMENT NEEDS GINGIVITIS
CONDITION PERIODONTAL
RIGHT 55 54 53 52 51 61 62 63 64 65 LEFT DISEASE
TEMPORARY TEETH MALOCCLUSION
SUPERNUMERARY
TOOTH
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 RETAINED
DECIDOUS TEETH
PERMANENT TEETH
DECUBITAL ULCER
CONDITION
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 CALCULUS
CLEFT PALATE
TREATMENT NEEDS ROOT FRAGMENT
TEMPORARY TEETH FLUOROSIS
RIGHT 85 84 83 82 81 71 72 73 74 75 LEFT OTHERS (Specify)
CONDITION

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:
IOL3RD
 Republic of the Philippines
Department of Education
Region VI – Western Visayas
(Region)
AKLAN
(Division)
LIBACAO
(District)

ALFONSO XII NATIONAL HIGH SCHOOL

(School)
Alfonso XII, libacao,Aklan
(School Address)

CERTIFICATE OF ENROLMENT

SEPTEMBER 15,2017

To Whom it May Concern:

This is to certify that JARED SCOTT E. RABAL has been

Name
enrolled for the School Year 2017-2018 with Learners Reference Number 115526060021

BITU-IN Z. SUGANOB
Teacher - Adviser
(Signature over Printed Name)

Certified True and correct:

ALADINO C. ZAULDA, JR.

School Head
(Signature over Printed Name)
IOL3RD
 Republic of the Philippines
Department of Education
Region VI – Western Visayas
(Region)
AKLAN
(Division)
LIBACAO
(District)

ALFONSO XII NATIONAL HIGH SCHOOL

(School)
Alfonso XII, Libacao, Aklan
(School Address)

CERTIFICATE OF COMPLETION

SEPTEMBER 15,2017

To Whom it May Concern:

This is to certify that JARED SCOTT E. RABAL

Name

has completed the Grade TEN level for the School Year 2016-2017

ALADINO C. ZAULDA,JR.
School Head
(Signature over Printed Name)

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 FORM 137-S
Department of Education
Bureau of Elementary Education
Region VI - Western Visayas
Division of Aklan
District of Libacao
LIBACAO NATIONAL FORESTRY & VOCATIONAL HIGH SCHOOL
Rizal Street, Poblacion, Libacao, Aklan

SECONDARY STUDENT'S PERMANENT RECORD

Name : PASCUA, KARL KENT L. Date of Birth : MAY 9, 2005
Address : Poblacion, Libacao, Aklan Place of Birth Manila Doctors Hospital, 667 United Nations Avenue, Manila
Sex : MALE LRN : 114786120067 School ID No. 114786
Parent/Guardian : ANTHONY C. PASCUA Occupation : OVERSEAS FILIPINO WORKER Date of Entrance: JUNE 11, 2012
Intermediate School LIBACAO CENTRAL ELEMENTARY SCHOOL School Year 2012-2013
Total number of years in school to complete elementary course: 6

Classified as School LIBACAO NATIONAL FORESTRY & VOCATIONAL HIGH SCHOOL Classified as School LIBACAO NATIONAL FORESTRY & VOCATIONAL HIGH SCHOOL
GRADE VII School Year 2013-2014 GRADE VIII School Year 2014-2015
JADE R. RUIZ

Grading Period Final ACTION Grading Period Final ACTION

Principal III

Subject Area Subject Area

1 2 3 4 Rating TAKEN 1 2 3 4 Rating TAKEN
Filipino 7 A A A A A(91) Passed Filipino 8 A A A A A(92.50) Passed
English 7 P A A A A(91) Passed English 8 P A A A A(91.25) Passed
Mathematics 7 99 - - P P A(89) Passed Mathematics 8 99 - - P P A(90.00) Passed
Science and Technology 7 A A A A A(92) Passed Science and Technology 8 A A A A A(90.25) Passed
Araling Panlipunan (AP) 7 P A P A A(90) Passed Araling Panlipunan (AP) 8 P A P A A(90.00) Passed
Technology & Livelihood Edication (TVE) 7 A A A A A(92) Passed Technology & Livelihood Edication (TVE) 8 A A A A A(91.25) Passed
MAPEH 7 A A A A A(92) Passed MAPEH 8 A A A A A(90.00) Passed
Certifed True Correct :

Edukasyon sa Pagpapahalaga (EP) 7 A A A A A(92) Passed Edukasyon sa Pagpapahalaga (EP) 8 A A A A A(90.00) Passed
General Average A(91.00) Passed General Average A(91.03) Passed

Number of School Days Number of Days Present Eligible for Admission to Number of School Days 201
Has advance units in Lack units in: Has advance units in Lack units in:
Total Number of year in school to date: Total Number of year in school to date:

Classified as School LIBACAO NATIONAL FORESTRY & VOCATIONAL HIGH SCHOOL Classified as School LIBACAO NATIONAL FORESTRY & VOCATIONAL HIGH SCHOOL
GRADE IX School Year 2015-2016 GRADE X School Year 2016-2017
Grading Period Final ACTION Grading Period Final ACTION
Subject Area Subject Area
1 2 3 4 Rating TAKEN 1 2 3 4 Rating TAKEN
Filipino 9 A A A A A(91) Passed Filipino 10 A A A A A(92.50) Passed
English 9 P A A A A(91) Passed English 10 P A A A A(91.25) Passed
Mathematics 9 99 - - P P A(89) Passed Mathematics 10 99 - - P P A(90.00) Passed
Science and Technology 9 A A A A A(92) Passed Science and Technology 10 A A A A A(90.25) Passed
Araling Panlipunan (AP) 9 P A P A A(90) Passed Araling Panlipunan (AP) 10 P A P A A(90.00) Passed
Technology & Livelihood Edication (TVE) 9 A A A A A(92) Passed Technology & Livelihood Edication (TVE) 10 A A A A A(91.25) Passed
MAPEH 9 A A A A A(92) Passed MAPEH 10 A A A A A(90.00) Passed
Edukasyon sa Pagpapahalaga (EP) 9 A A A A A(92) Passed Edukasyon sa Pagpapahalaga (EP) 10 A A A A A(90.00) Passed
Citizen Army Training (CAT) I
JOSEPHINE I. ORTEGA

General Average A(91.00) Passed General Average A(91.03) Passed

Number of School Days Number of Days Present Eligible for Admission to Number of School Days 201
Has advance units in Lack units in: Has advance units in Lack units in:
Adviser

Total Number of year in school to date: Total Number of year in school to date:

REMARKS
Remarks on the and habits of the students:

Classified as School LIBACAO NATIONAL FORESTRY & VOCATIONAL HIGH SCHOOL Classified as School LIBACAO NATIONAL FORESTRY & VOCATIONAL HIGH SCHOOL
GRADE XI School Year 2017-2018 GRADE XII School Year 2017-2018
Grading Period Final ACTION Grading Period Final ACTION
Subject Area Subject Area
1 2 3 4 Rating TAKEN 1 2 3 4 Rating TAKEN
Empowerment Technologies A A A A A(91) Passed
Humanities I (Community Engagement, Solidarity P A and Citizenship)
A A A(91) Passed
P.E. and Health 99 - - P P A(89) Passed
Certifed True Copy :

Oral Communication A A A A A(92) Passed

Komunikasyon at Pananaliksik sa Wi P A P A A(90) Passed
Understanding Culture, Society and Politics A A A A A(92) Passed
General Mathematics A A A A A(92) Passed
English for Academic and Professional Purpose A A A A A(92) Passed
Earth and Life Science 99 - - P P A(92) Passed

General Average A(91.00) Passed

Number of School Days Number of Days Present Number of School Days Number of Days Present
Has advance units in Lack units in: Has advance units in Lack units in:
Total Number of year in school to date: Total Number of year in school to date:

CERTIFICATE OF TRANSFER
TO WHOM IT MAY CONCERN
This is to certify that this is a true record o issued this day of for athletic/sports purposes only

He/She is eligible for transfer and admission to Grade as c regular c irregular student and has no money or personal
responsibility in the school.

JADE R. RUIZ
JANUARY 5, 2017 Principal III
Date

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