Revised as of September 26, 2019
COMMISSION ON EDUCATION
Diocese of Kabankalan
DIOCESAN SPORTSFEST 2023
KABANKALAN CATHOLIC COLLEGE
ATHLETES’ DOCUMENTS
BASKETBALL
BOYS
ROXANNE D. ARIAN
Coach
09398827561
COMMISSION ON EDUCATION
Diocese of Kabankalan
DIOCESAN SPORTSFEST 2023
OFFICIAL ENTRY FORM
EVENT:
SCHOOL:
CERTIFICATE
MEDICAL PARENTS’
NAME OF
CERTIFICATE CONSENT
REMARKS
ENROLLMENT
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Prepared by: Noted by:
JUAN DELA CRUZ MARIA MAKILING
Coach Principal
Screened by: Validated by:
___________________________________ ___________________________
SCREENING COMMITTEE MEMBER SCREENING COM HEAD
SCHOOL LETTER HEAD
CERTIFICATION
DATE: __________
TO WHOM IT MAY CONCERN,
This is to certify that the following studentd are officially enrolled this School
Year 2022-2023:
Name and Grade of Athletes
(One event, one certificate of enrollment. Example, enumerate here all basketball
players. Another certificate for volleyball, takraw, etc.)
This certification is issued for reference purpose only.
School Registrar
COMMISSION ON EDUCATION
Diocese of Kabankalan
DIOCESAN SPORTSFEST 2023
MEDICAL CERTIFICATE
To Whom It May Concern:
This is to certify that I have personally examined ___________________ age ____ sex _____ and
Name
have found that he/she is physically fit unfit, during the time of examination, to join and
participate in the COE - Diocesan Sportsfest.
Event: ___________________________
Remarks/Findings:
Ht ._______cm Wt:_______kg BP.____________mmHg
PR:____________bpm RR:____________cpm
Physical Examination
School/Intrams/ Unit/Division Regional Meet Palarong
District Meet Meet Pambansa
Normal Normal Normal Normal
1. Eyes YES | NO YES | NO YES | NO YES | NO
2. Ears, Nose, Throat YES | NO YES | NO YES | NO YES | NO
3. Mouth and Teeth YES | NO YES | NO YES | NO YES | NO
4. Neck YES | NO YES | NO YES | NO YES | NO
5. Cardiovascular YES | NO YES | NO YES | NO YES | NO
6. Chest and Lungs YES | NO YES | NO YES | NO YES | NO
7. Abdomen YES | NO YES | NO YES | NO YES | NO
8. Skin YES | NO YES | NO YES | NO YES | NO
9. Genitalia-Hernia (male) YES | NO YES | NO YES | NO YES | NO
10. Muskuloskeletal: ROM YES | NO YES | NO YES | NO YES | NO
a. neck YES | NO YES | NO YES | NO YES | NO
b. spine YES | NO YES | NO YES | NO YES | NO
c. shoulder YES | NO YES | NO YES | NO YES | NO
d. arms/hands YES | NO YES | NO YES | NO YES | NO
e. hips YES | NO YES | NO YES | NO YES | NO
f. thighs YES | NO YES | NO YES | NO YES | NO
g. knees YES | NO YES | NO YES | NO YES | NO
h. ankles YES | NO YES | NO YES | NO YES | NO
i. feet YES | NO YES | NO YES | NO YES | NO
11. Neuromuscular (reflexes) YES | NO YES | NO YES | NO YES | NO
_____________________________
Physician/Medical Officer
(signature over printed name)
PRC LICENSE:
PTR NO.
COMMISSION ON EDUCATION
Diocese of Kabankalan
DIOCESAN SPORTSFEST 2023
_____________________
Date
PARENTAL CONSENT
I/We hereby willingly and voluntarily give consent to the participation of my/our
son/daughter _____________________________ in _______________ in the Diocesan
Sportsfest on March 30-31, 2023 to be held at Kabankalan Catholic College - Kabankalan
City, Negros Occidental.
I/We have considered the benefits that my son or daughter will derive from
his/her participation in this activity provided that due care, diligence and necessary
precautions will be observed to ensure his/her health and safety.
Further, I/We authorize the personnel of Commission on Education to collect,
process, retain, and dispose of personal information of the above-mentioned athlete in
accordance with the Data Privacy Act of 2012.
Signature of Father Over Printed Name Signature of Mother Over Printed Name
Verified:
Adviser School Head/Registrar
(Signature Over Printed Name) (Signature Over Printed Name)
Remarks:
Note:
Submit the necessary documents, i.e. Affidavit/Sworn Statement of Actual Care and Custody duly
verified by the adviser and school head, in cases signature of parents are unavailable.
INFO
Page 1 is the Cover Page
Page 2 Official Entry form
Page 3 Certificate of Enrollment per Event
Page 4 Medical Certificate
Page 5 Parental Consent
Prepare two copies of the documents in white folder
COver page should be pasted outside the folder.
COMMISSION ON EDUCATION
Diocese of Kabankalan
March 10, 2023
HON. BENJIE M. MIRANDA
City Mayor
Kabankalan City, Negros Occidental
Dear Hon. Mayor Miranda,
Christian Greetings of love and peace in the name of our Lord!
The Commission on Education of the Diocese of Kabankalan is an evangelizing arm of the
diocese that promotes the common goals of the parochial schools through nurturing solidarity and
harmony. One part of the course of action in fulfilling these goals is the organization of
sportsmeet and competition to be participated by 18 Diocesan Schools from Hinoba-an to
Hinigaran.
This year, the COE organizes the Diocesan Sportsfest which will be on March 30-31, 2023. For
the success of the activity, we are respectfully asking appproval from your office on the
following:
Conduct of our grand parade from the Old St. Francis Xavier Cathedral to KCC around
8:30 AM on March 30.
Use of the Kabankalan City Cultural and Sports Center as venue for Badminton
Use of Kabankalan Table Tennis Center as venue for Table Tennis.
You can trust that these facilities will be kept tidy and arranged.
We're hoping you'll respond favorably.
Many thanks, and God bless you!
Respectfully,
ROXANNE D. ARIAN-CABARUBIAS, LPT, MAEd
Overall Tournament Manager
Noted by:
REV. FR. RICHARD LACHICA
Chairman, Commission on Education
COMMISSION ON EDUCATION
Diocese of Kabankalan
March 10, 2023
HON.DARYL GAROLACAN
Barangay Chairman
Brgy. 3, Kabankalan City, Negros Occidental
Dear Hon. Garolacan,
Christian Greetings of love and peace in the name of our Lord!
The Commission on Education of the Diocese of Kabankalan is an evangelizing arm of
the diocese that promotes the common goals of the parochial schools through nurturing
solidarity and harmony. One part of the course of action in fulfilling these goals is the
organization of sportsmeet and competition to be participated by 18 Diocesan Schools
from Hinoba-an to Hinigaran.
This year, the COE organizes the Diocesan Sportsfest which will be on March 30-31,
2023. For the success of the activity, we are respectfully asking appproval from your
office for the use of the basketball court of your barangay on March 30-31 from 7:00AM
- 6:00PM.
You can trust that these facilities will be kept tidy and arranged.
We're hoping you'll respond favorably.
Many thanks, and God bless you!
Respectfully,
ROXANNE D. ARIAN-CABARUBIAS, LPT, MAEd
Overall Tournament Manager
Noted by:
REV. FR. RICHARD LACHICA
Chairman, Commission on Education
COMMISSION ON EDUCATION
Diocese of Kabankalan
March 10, 2023
HON.GERARDO M. TABUJARA SR.
Barangay Chairman
Brgy. 1, Kabankalan City, Negros Occidental
Dear Hon. Tabujara,
Christian Greetings of love and peace in the name of our Lord!
The Commission on Education of the Diocese of Kabankalan is an evangelizing arm of
the diocese that promotes the common goals of the parochial schools through nurturing
solidarity and harmony. One part of the course of action in fulfilling these goals is the
organization of sportsmeet and competition to be participated by 18 Diocesan Schools
from Hinoba-an to Hinigaran.
This year, the COE organizes the Diocesan Sportsfest which will be on March 30-31,
2023. For the success of the activity, we are respectfully asking appproval from your
office for the use of the basketball court of your barangay on March 30-31 from 7:00AM
- 6:00PM.
You can trust that these facilities will be kept tidy and arranged.
We're hoping you'll respond favorably.
Many thanks, and God bless you!
Respectfully,
ROXANNE D. ARIAN-CABARUBIAS, LPT, MAEd
Overall Tournament Manager
Noted by:
REV. FR. RICHARD LACHICA
Chairman, Commission on Education
