Republic of the Philippines

Department of Education
BUREAU OF LEARNER SUPPORT SERVICES
FORM SSC.2: School Sports Club Attachment Form

INSTRUCTIONS: 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.
Sport’s Club Name: RAWIS E/S BASKETBALL CLUB
Established Date: 01/14/2023
Sports Club Facilitator/s: MARY JANE N. LONSAME
Sports Club Member/s: JOSEPHINE A. NEBREJA
Members’ Name Grade Level
1. JOSHEN O. NUARIN VI- Jupiter
2.JOHN ERIC O. OXIANO VI-Jupiter
3.DENVER ACE O. PAJALLA VI-Jupiter
4.FLOYD N. LONSAME IV-Saturn
5.ARCHIE MUJAR IV-Saturn
6.ACUILYS O. STA. MARIA V-Pluto
7. DANIEL S. OLAGUER V-Pluto
8. CHRIS JAMES N. NOVENO V-Pluto
9.LANCE KERBIE A. NEBREJA V-Pluto
10.EMIL LAWRENCE H. POLLOSO VI-Saturn

Sport’s Club Name: RAWIS ES ATHLETICS CLUB

Established Date: 01/14/2023
Sports Club Facilitator/s: GLENDA A. RADASA
Sports Club Member/s:
Members’ Name Grade Level
1. BENJIE ODEÑA III-Earth
2. MARK JUSTIN PAJALLA III-Earth
3. JULIANE MUJAR III-Earth
4. CHRISTOPHER MANAHAN JR II-Mercury
5. MARK JAME G. NATIVIDAD III-Earth
6. XYRUS CARL M. RAZO III-Earth
7. RIANAH JOY N. OXIANO IV-Saturn
8. JOSHUA L. PADIOS IV-Saturn
9.
10.

Sport’s Club Name: RAWIS E/S BADMINTON CLUB

Established Date:01/14/2023
Sports Club Facilitator/s:YAMY CARDOSO
Sports Club Member/s:
Members’ Name Grade Level
1.STEPHANIE MAE P. BASIAG V-Pluto
2. SHIENE N. STA. MARIA VI-Jupiter
3.JOHN FRANCIS NIÑOFRANCO V-Pluto
4.PRECIOUS ANGEL O. PALOYO VI-Jupiter
5.

3F Mabini Building, DepEd Complex, Meralco Avenue, Pasig City

Telephone No.: (02) 632-9935; (02) 638-8525
 6.
7.
8.
9.
10.

Sport’s Club Name: RAWIS E/S CHESS CLUB

Established Date:01/14/2023
Sports Club Facilitator/s: KATRINA JOYCE R. BRONZAL
Sports Club Member/s:
Members’ Name Grade Level
1.BRIJIEN RUZHEL G. DACIAN V-Pluto
2.
3.
4.
5.
6.
7.
8.
9.
10.

Sport’s Club Name: RAWIS E/S ARNIS CLUB

Established Date:01/14/2023
Sports Club Facilitator/s: VILMA M. DAYTO
Sports Club Member/s:
Members’ Name Grade Level
1.ARJAY NOTOB V-Pluto
2.WINJAN MARTIN P. PAJALLA II-Mercury
3.ALWIN O. PADIOS JR VI-Jupiter
4.
5.
6.
7.
8.
9.
10.

II. PROGRAMMING
Put the preferred time schedule. Add rows and columns if necessary.
Time Sports Club Mon Tues Wed Thurs Fri Sat
Example
3:00PM-4:00PM Arnis Sports Club /
4:00PM-5:00PM Chess Sports Club /
5:00PM-6:00PM Basketball Sports Club /

Put the preferred time schedule. Add rows and columns if necessary.
Time Varsity Club Mon Tues Wed Thurs Fri Sat
3:00PM-4:00PM BASKETBALL CLUB ∕
4:00PM-4:30PM ATHLETICS ∕
4:00PM-5:00PM BADMINTON ∕
3F Mabini Building, DepEd Complex, Meralco Avenue, Pasig City
Telephone No.: (02) 632-9935; (02) 638-8525
 4:00PM-4:30PM ARNIS ∕
4:00PM-5:00PM CHESS ∕

III. LIST OF AVAILABLE SPORTS EQUIPMENT 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 Present
Volleyball court
Swimming pool
Football/ softball/ baseball field
Spacious playing area Present
Others: ___________________
___________________
___________________

Sports Equipment Remarks

CHESS BOARD PRESENT/IN GOOD
CONDITION
BADMINTON NET PRESENT/IN GOOD
CONDITION
BASKET BALL PRESENT/IN GOOD
CONDITION
SHUTTLE COCK PRESENT/IN GOOD
CONDITION
RACKET PRESENT/IN GOOD
CONDITION

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.N/A

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.
3F Mabini Building, DepEd Complex, Meralco Avenue, Pasig City
Telephone No.: (02) 632-9935; (02) 638-8525
Prepared by:
Sports Club Coordinator JHONABEL P. MONDEJAR

Signature

Date FEBRUARY 8, 2023

Certified by:
Principal/Officer-in-Charge EDWIN D. NACION JR

Signature

Date FEBRUARY 8, 2023

Verified by:
Division Sports Officer DANILO R. MURILLO
Signature
Date

3F Mabini Building, DepEd Complex, Meralco Avenue, Pasig City

Telephone No.: (02) 632-9935; (02) 638-8525