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Republic of the Philippines

Department of Education
BUREAU OF LEARNERS SUPPORT SERVICES

FORM SSC.1: SCHOOL SPORTS CLUB REGISTRATION FORM

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

C.2 Preferred Sports


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

FORM SSC.2: School Sports Club Attachment Form

INSTRUCTION: Input the necessary details. Indicate N/A if not applicable.


DO NOT ABBREVIATE.

I. SPORTS CLUB INFORMATION

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 LADY VIPERS- VOLLEYBALL


Establish Date:
Sports Club Facilitator/s: MILDRED ELAINE G. YABA
Sports Club Member/s: LENIE CAGATIN/ LEIZEL JOY RILLO
Members’ Name Grade Level
1. Ashliah Lamanta 9
2. Angelyn Baclaan 9
3. Joana Ugpay 10
4. Fatima Gawilan 10
5. Lea Rojo 10
6. Airose Asil 9
7. Rose Marie Guinita 9
8. Karen Joy Ugpay 9
9. Jessa Mae Jimenez 9
10. Jessa Hamoner 9
11. Cristine Maglasang 10
12. Christine Caballero 10

Sports Club Name: SIS VIPERS- VOLLEYBALL BOYS (JHS\SH)


Establish Date:
Sports Club Facilitator/s: ELMER Q. CAMAD
Sports Club Member/s: MARIO MANTANGKIL
Members’ Name Grade Level
1. Batawan, Wenie 9-Singapore
2. Bentang, Joven 11-Newton
3. Cagape, Remark 9-Singapore
4. Dagangon, Raymond 11-Newton
5. Gawilan, Jepriel 8-Thailand
6. Gawilan, Jhon Ariel 7-Korea
7. Gawilan, Keven Glend 9-Singapore
8. Gawilan, Prince Jay-ar 10-Japan
9. Landas, Jhon Mark 9-Singapore
10. Remadavia, Rolando Jr. 11-Newton
11. Simbuangan, Narding 9-Singapore
12. Villagracia, Daniel 9-Singapore
13. Wabe, Jerald 8-Thailand

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 BADMINTON BOYS-ELEMENTARY


Establish Date:
Sports Club Facilitator/s: ANGELIE AMANTE
Sports Club Member/s: JANRELYN ARBELLO
Members’ Name Grade Level
1. KIRK JOSHUA ENERO 6
2. GILJOHN ONGA 6
3. RODEREX GAWILAN 6
4.

Sports Club Name: SIS VIPERS BADMINTON BOYS- HIGH SCHOOL


Establish Date:
Sports Club Facilitator/s: LENYVIBS LIMBAG
Sports Club Member/s: NORAVELLE PADAYOGDOG
Members’ Name Grade Level
1. BERNARD EJANEL 11-NEWTON

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 BILLIARDS CLUB- BOYS/GIRLS


Establish Date:
Sports Club Facilitator/s: NIEL MONTEJO
Sports Club Member/s: GILBERT ROSALITA
Members’ Name Grade Level
1. REMARK J. CAGAPE 9-SINGAPORE
2. NANCY B. BENTANG 10-JAPAN
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

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.

Learning Facilities Remarks


Track and field oval
/
Gymnasium/ Covered Court
Basketball Court
Volleyball Court
Swimming Pool
Football /softball/ baseball field
Spacious playing area
Others: _______________
_______________
_______________
Sports Equipment Remarks
IV. SPORTS ACTIVITIES, PROGRAMS AND/OR PROJECTS
Give at least (3) three recent activities, programs, projects or any other initiatives implemented related to sports.
Add rows if necessary.

Activities/ Programs/ Projects Date of Implementation


1.

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

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