Professional Documents
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Sports - Club. Forms
Sports - Club. Forms
Department of Education
BUREAU OF LEARNERS SUPPORT SERVICES
INSTRUCTION: Input the necessary details. Indicate N/A if not applicable. DO NOT ABBREVIATE.
A. Basic Information
Regio X Division Bukidnon
n
Name of School Sagundanon Integrated School School ID 501673
Address Sagundanon, KItaotao, Bukidnon
Email address (if any) Telephone No.
Website URL (if any)
B. School Profile
C. Sports Club
C.1 Mandatory Sports
At least three out of six mandatory sports; however you may establish any preferred sports club.
Add rows if necessary.
1. Track & Field
2. Badminton
3. Volleyball
4. Billiards
5. Table Tennis
6. Basketball
7. Chess
Declaration:
I hereby declare the information provided in this application is true and correct and there have been no
misleading statements, omission of any relevant facts nor any misinterpretation made.
Prepared by:
Sports Club Coordinator JAYVEE D. ABALOS
Signature
Date
Certified by:
Principal/Officer-In-Charge RICK JOHN T. GULBEN
Signature
Date
Verified by:
Division Sports Officer
Signature
Date
This form is not valid if not signed.
Required Attached Document: Accomplish Form SSC.2. School Sports Club Attachment Form
Republic of the Philippines
Department of Education
BUREAU OF LEARNERS SUPPORT SERVICES
Create a copy of this page if four or more sports clubs are being offered. Add rows and columns if necessary.
Sports Club Name: SIS VIPERS (BOYS)-BASKETBALL 3x3 (High School Department)
Establish Date: November 10,2023
Sports Club Facilitator/s: JAYVEE ABALOS
Sports Club Member/s: DANREX SUMANDANG
Members’ Name Grade Level
1. Dexter Binaton 9-SINGAPORE
2. Jefriel Sumandang 11-NEWTON
3. Jeodio Libo 9-SINGAPORE
4. Rey Damali 10-JAPAN
Sports Club Name: SIS VIPERS CHESS CLUB- HIGH SCHOOL (BOYS/GIRLS)
Establish Date:
Sports Club Facilitator/s: GISELL E. NOB
Sports Club Member/s: ELRECK VON T. GULBEN
Members’ Name Grade Level
1. JAYFER PUERTE 8
2. BAMBI SUMBAD 10
3.
4.
5.
Sports Club Name: SIS VIPERS TRACK AND FIELD CLUB- BOYS/GIRLS(JHS/SHS)
Establish Date:
Sports Club Facilitator/s: ERWEN DONGALLO
Sports Club Member/s: GILBERT ROSALITA
Members’ Name Grade Level
1. RAYMOND DAGANGON 11-NEWTON
2. JHON PAUL TACYAWAN 11-NEWTON
3. JHONREY T. GAWILAN 11-NEWTON
4. JEZRIEL MAGLASANG 7-MALDIVES
5. TITAROSE TAMBOG 7-KOREA
6. CHRISTINE MAGLASANG 9-SINGAPORE
7. CONY MANTAGUIMA 8-THAILAND
Sports Club Name: SIS VIPERS TABLE TENNIS BOYS/GIRLS- HIGH SCHOOL
Establish Date:
Sports Club Facilitator/s: MAE BESTUDIO
Sports Club Member/s:
Members’ Name Grade Level
1. NEDY DALYN Y. MANGUASON 11-NEWTON
2.
3.
4.
Sports Club Name: SIS VIPERS TABLE TENNIS BOYS/GIRLS-ELEMENTARY
Establish Date:
Sports Club Facilitator/s: MAE BESTUDIO
Sports Club Member/s:
Members’ Name Grade Level
1. KIRK JOSHUA T. ENERO 6-SAPPHIRE
2. JAYBOY RILLO 6-SAPPHIRE
3. JAMES JIMENEZ 4-CITRINE
4. MARIA TIFFANY UGPAY 6-SAPPHIRE
5. LEJANIE GAMAO 4-CITRINE
6. ELJOY GAMAO 6-SAPPHIRE
II. PROGRAMMING
Put the preferred time schedule. Add rows and columns if necessary.
Time Sports Club Mon Tues Wed Thurs Fri Sat
III. LIST OF AVAILABLE SPORTS EQUIPEMENT AND SPORTS FACILITIES
Tick the box if standard sports equipment and facilities are available and ready to use. Put remarks and add rows if necessary.
2.
3.
Declaration:
I hereby declare the information provided in this application is true and correct and there have been no
misleading statements, omission of any relevant facts nor any misinterpretation made.
Prepared by:
Sports Club Coordinator JAYVEE D. ABALOS
Signature
Date
Certified by:
Principal/Officer-In-Charge RICKY JOHN T. GULBEN
Signature
Date
Verified by:
Division Sports Officer
Signature
Date